title: Statin therapy is associated with lower all-cause mortality in patients with non-obstructive coronary artery disease.
abstract: OBJECTIVE
  Non-obstructive coronary artery disease (CAD) is a frequent clinical condition and is associated with an increase in cardiovascular events. However, appropriate medical therapy for this population is not known. We investigated the association between statin use and risk of all-cause mortality and coronary revascularization in patients with non-obstructive CAD.
  
  
  METHODS
  From 2007 to 2011, we identified 8372 consecutive patients with non-obstructive CAD (1-49% stenosis) documented by coronary computed tomography angiography (CCTA) from 3 medical centers. Patients with statins or aspirin use before CCTA, and a history of revascularization before initial CCTA were excluded. All-cause mortality and a composite of mortality and late coronary revascularization (>90 days after CCTA) were analyzed according to the use of statins.
  
  
  RESULTS
  Mean age of the study population was 61.4 ± 10.9 years and 70.3% were male. Statins were prescribed to 1983 (23.7%) patients. During 828 days of follow-up (IQR 385-1342), 221 (2.6%) cases of all-cause mortality and 295 (3.5%) cases of the composite endpoint were observed. Statin therapy was associated with lower risks of all-cause mortality (adjusted HR 0.397; 95% CI 0.262-0.602; p < 0.0001) and composite endpoint (adjusted HR 0.430; 95% CI 0.310-0.597; p < 0.0001). Association between statin therapy and better clinical outcomes was regardless of age, sex, presence of hypertension or diabetes, coronary artery calcium score, low-density lipoprotein cholesterol levels, high-sensitivity C-reactive protein levels, or glomerular filtration rate.
  
  
  CONCLUSIONS
  Statin therapy was associated with a lower risk of all-cause mortality in patients with non-obstructive CAD documented by CCTA, regardless of combined clinical risk factors.
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors: In-Chang
authors: IC
authors: Hwang
authors: Department of Statistics, Sungkyunkwan University, Seoul, Republic of Korea.
authors: Joo-Yeong
authors: JY
authors: Jeon
authors: Institute of Health and Environment, School of Public Health, Seoul National University, Seoul, Republic of Korea.
authors: Younhee
authors: Y
authors: Kim
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors: Hyue Mee
authors: HM
authors: Kim
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors: Yeonyee E
authors: YE
authors: Yoon
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors: Seung-Pyo
authors: SP
authors: Lee
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors: Hyung-Kwan
authors: HK
authors: Kim
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors: Dae-Won
authors: DW
authors: Sohn
authors: Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: jidong.sung@samsung.com.
authors: Jidong
authors: J
authors: Sung
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: kimdamas@snu.ac.kr.
authors: Yong-Jin
authors: YJ
authors: Kim
mesh_terms: D000368:Aged; D002114:Calcinosis; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D023921:Coronary Stenosis / Q000503:physiopathology; D003331:Coronary Vessels / Q000473:pathology; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D009026:Mortality; D062645:Percutaneous Coronary Intervention; D056910:Republic of Korea; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Atherosclerosis; Coronary artery disease; Coronary computed tomography angiography; Statin