title: The effects of statin therapy on carotid plaque composition and volume: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Prior studies have demonstrated that statin use stabilizes and diminishes atherosclerotic lesions. The main objective of this systematic review and meta-analysis was to study the effects of statin therapy on carotid plaque composition as seen on serial high-resolution carotid plaque MRI. We hypothesized that statin therapy would result in significant improvements in lipid-rich-necrotic-core (LRNC) volumes, wall volumes and lumen volumes.
  
  
  METHODS
  Prospective studies using serial high-resolution carotid plaque MRI (1.5 or 3T only) in patients on statin therapy to document changes in carotid plaque composition were included. All studies had a minimum of 10 patients and minimum follow-up duration of 3 months. Outcomes included change in LRNC volume, wall volume, and lumen volume at: (1) 1-6 months; (2) 7-12 months; (3) >12 months following initiation of statin therapy; and (4) at last follow-up. Meta-analysis was performed using the random effects model. Results were reported as weighted mean differences (WMD) and 95% confidence interval (CI).
  
  
  RESULTS
  Seven studies including 361 patients were included. There was no significant change in carotid wall volume or lumen volume at any time points. While there was no significant difference in LRNC at 1-6 months and at 7-12 months following initiation of statin therapy; at >12 months, there was significant decrease in LRNC volume (WMD=-9.9mm3, 95% CI=-8.9, -2.3).
  
  
  CONCLUSIONS
  Our study suggests statin therapy is associated with significant reductions in LRNC at 1-year of statin therapy on serial carotid MRI. However, no significant reduction in carotid wall volume was seen.
authors.affiliation: Department of radiology, Mayo Clinic, 200, 1st Street SW, 55905 Rochester, MN, United States. Electronic address: brinjikji.waleed@mayo.edu.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: Department of radiology, Mayo Clinic, 200, 1st Street SW, 55905 Rochester, MN, United States.
authors.forename: Vance T
authors.initials: VT
authors.lastname: Lehman
authors.affiliation: Department of radiology, Mayo Clinic, 200, 1st Street SW, 55905 Rochester, MN, United States.
authors.forename: David F
authors.initials: DF
authors.lastname: Kallmes
authors.affiliation: Department of neurology, Rochester, MN, United States.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.affiliation: Department of neurosurgery, Rochester, MN, United States.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lanzino
authors.affiliation: Center for the science of healthcare delivery, Mayo Clinic, Rochester, MN, United States.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Murad
authors.affiliation: Department of cardiology, Mayo Clinic, Rochester, MN, United States.
authors.forename: Sharon
authors.initials: S
authors.lastname: Mulvagh
authors.affiliation: Department of neurology, Rochester, MN, United States.
authors.forename: James
authors.initials: J
authors.lastname: Klaas
authors.affiliation: Department of neurology, Rochester, MN, United States.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Graff-Radford
authors.affiliation: Department of radiology, Walter Reed Medical Center, Bethesda, MD, United States.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: DeMarco
authors.affiliation: Department of radiology, Mayo Clinic, 200, 1st Street SW, 55905 Rochester, MN, United States.
authors.forename: John
authors.initials: J
authors.lastname: Huston Iii
mesh_terms: D002340:Carotid Artery Diseases / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D058226:Plaque, Atherosclerotic / Q000188:drug therapy* / Q000473:pathology*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Carotid stenosis; MRI; Plaque; Statin