title: The Effect of Statin Therapy on Coronary Plaque Composition Using Virtual Histology Intravascular Ultrasound: A Meta-Analysis.
abstract: OBJECTIVE
  Previous studies have indicated that statin therapy may promote plaque regression. However, the impact of statin therapy on plaque composition has not been clearly elucidated. We performed a meta-analysis to investigate the effect of statin therapy on coronary plaque composition as assessed by virtual histology intravascular ultrasound (VH-IVUS).
  
  
  METHODS
  Online databases were searched from inception to March 1, 2015. Studies providing VH-IVUS volumetric analyses of coronary plaque composition at baseline and follow-up in patients receiving statin therapy were included. Weighted mean difference (WMD) using a random-effects model was used.
  
  
  RESULTS
  Ten studies involving 682 patients were included. There was a substantial reduction in fibrous volume between baseline and follow-up (WMD: -2.37 mm3, 95% confidence interval (CI) -4.01 to -0.74 mm3, P=0.004), and a significant increase in dense calcium (DC) volume (WMD: 0.89 mm3, 95% CI 0.70 to 1.08 mm3, P<0.00001). No significant change was seen in fibro-fatty and necrotic core (NC) volumes. In stratified analyses, the fibrous volume was decreased significantly (WMD: -3.39 mm3, 95% CI -6.56 to -0.21 mm3, P=0.04) and the absolute DC volume (WMD: 0.99 mm3, 95% CI 0.23 to 1.76 mm3, P=0.01) was increased in the subgroup with ≥12 months follow-up, whereas no significant change was observed in the subgroup with < 12 months follow-up. Similarly, a substantial decrease in fibrous volume (WMD: -2.01 mm3, 95% CI -3.05 to -0.96 mm3, P< 0.0002) and an increase in DC volume (WMD: 0.90 mm3, 95% CI 0.70 to 1.10 mm3, P< 0.00001) were observed in the subgroup with high-intensive statin therapy, while the change in fibrous and DC volumes approached statistical significance (P=0.05 and P=0.05, respectively) in the subgroup with low-intensive statin therapy.
  
  
  CONCLUSIONS
  Statin treatment, particularly of high-intensity and long-term duration, induced a marked modification in coronary plaque composition including a decrease in fibrous tissue and an increase in DC.
authors.affiliation: The First Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China; Department of Cardiology, Zhangzhou Hospital Affiliated to Fujian Medical University, Fujian, China.
authors.forename: Guian
authors.initials: G
authors.lastname: Zheng
authors.affiliation: Department of Advanced Cardiovascular Imaging Analysis, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Yuxin
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Molecular Biology, Zhangzhou Medical Science Institute, Fujian, China.
authors.forename: Huishan
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Hematology, Zhejiang Institute of Hematology, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Jinghan
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirayama
authors.affiliation: The First Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China; Department of Cardiology, First Affiliated Hospital of Fujian Medical University, Fujian, China.
authors.forename: Jinxiu
authors.initials: J
authors.lastname: Lin
mesh_terms: D000368:Aged; D002118:Calcium / Q000378:metabolism; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology*; D018084:Ultrasonography, Interventional / Q000379:methods
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002118:Calcium