Coronary disease & ACSCohort study
Quantitative Coronary Atherosclerotic Plaque Burden From CCTA and the Benefit From Lipid-Lowering Medication
- observational cohort study
- consecutive
Authors' conclusion
In symptomatic patients with suspected CAD, LLM after coronary computed tomography angiography was associated with a lower rate of adverse events during long-term follow-up among those with PAV >5%, even in the absence of obstructive CAD. The quantification of coronary atherosclerotic plaque burden is a potential marker to guide preventive lipid-lowering therapy.
Study context
- Population
- Symptomatic patients undergoing coronary computed tomography angiography for suspected coronary artery disease (CAD)Percent atheroma volume (PAV) >5% 910 · PAV ≤5% 1,359
- Participants
- 2,269 patients
- Exposure
- use of lipid-lowering medication (LLM)
- Users of LLMn = 1,261
Main finding
As reported in the abstract
Composite of:
- Death
- Myocardial infarction
- Unstable angina
Patients who experienced the composite end point during follow-up
255 (11%)
Observational data: associations, not effects.
Further findings
| Outcome | Users of LLM | Nonusers of LLM | P value |
|---|---|---|---|
| Median PAV | median 6.6% | median 1.4% | P < 0.001 |
| Annual event rate among patients with PAV >5% | annual event rate 2.62% | annual event rate 4.14% | adjusted P =0.002 |
| Annual event rate among patients with PAV ≤5% | annual event rate 0.94% | annual event rate 0.65% | adjusted P =0.717 |
- Annual event rate among patients with PAV >5%: improved outcomes with LLM, even in the absence of obstructive CAD
- Annual event rate among patients with PAV >5%: 910 patients with PAV >5%
- Annual event rate among patients with PAV ≤5%: 1359 patients with PAV ≤5%
PAV threshold for prognostic benefit from LLM (adjusted Cox regression with PAV × LLM interaction)
- Suggested PAV threshold
- between 4% and 10%
Original publication
Quantitative Coronary Atherosclerotic Plaque Burden From CCTA and the Benefit From Lipid-Lowering Medication. Circ Cardiovasc Imaging. Published 6 April 2026. doi:10.1161/circimaging.125.018840
Summarised from the published abstract; every number is checked against it