. 2023 Nov 28;12(23):e031676. doi: 10.1161/JAHA.123.031676

Table 1.

Summary of HMG‐CoA Reductase Inhibitor (n=14) and Other Lipid‐Lowering Agent (n=2) Study Characteristics and Cardiovascular Calcification Outcome

Author and year	Mean study duration, mo	Target population	Study sample size	Intervention	Comparator	Primary or secondary end point	Imaging modality	Site	Reported outcomes	Interpretation
Arad 2005 ¹¹	48	Age 50–70 y with known CAC	1005	20 mg atorvastatin daily, 1 g vitamin C daily, 1000 IU vitamin E daily	Placebo	Secondary	CT	Coronary artery	$∆$ CAC (AU); 331±421 treatment vs 323±385 control (P=0.80)	No significant attenuation
Cowell 2005 ¹²	25	Calcific aortic stenosis	155	80 mg atorvastatin daily	Placebo	Primary	CT	Aortic valve	$∆$ Valvular calcification (mean %±SD); 22.3±21 treatment vs 21.7±21 control (P=0.93)	No significant change in aortic valve calcium score
Dichtl 2008 ¹³	28	Calcific aortic stenosis	47	20 mg atorvastatin daily	Placebo	Primary, aortic valve calcification;	CT	Aortic valve and coronary artery	Not reported; P=n.s.	No significant attenuation
Dichtl 2008 ¹³	28	Calcific aortic stenosis	47	20 mg atorvastatin daily	Placebo	secondary, CAC	CT	Aortic valve and coronary artery	Not reported; P=n.s.	No significant attenuation
Egede 2013 ⁵⁰	12	ST‐segment–elevation myocardial infarction	87	40 mg rosuvastatin daily	5 mg rosuvastatin daily	Primary	VH‐IVUS	Coronary artery	$∆$ Dense calcium (mean %±SD); 0.8±3.7 treatment vs −0.3±3.2 control (P=0.19)	No significant attenuation of dense calcium
Hougaard 2020 ⁵³	12	ST‐segment–elevation myocardial infarction	87	80 mg atorvastatin daily and ezetimibe 10 mg daily	80 mg atorvastatin daily	Secondary	OCT	Nonculprit study plaque in noninfarct‐related coronary artery	$∆$ Calcium arc, median $μ$ m (IQR); 43.7 (−32.9 to 172.8) treatment vs 20.7 (−9.9 to 205.2) control (P=0.77)	No significant attenuation in arcs of calcific plaque
Houslay 2006 ¹⁴	24	Calcific aortic stenosis	102	80 mg atorvastatin daily	Placebo	Primary	CT	Coronary artery	$∆$ CAC (log AU); 0.234±0.037 treatment vs 0.167±0.034 control (P=0.18)	No significant attenuation
Lee 2016 ⁵²	3	Acute coronary syndrome requiring percutaneous coronary intervention	70	Ezetimibe/simvastatin 10/40 mg daily	Pravastatin 20 mg daily	Secondary	VH‐IVUS	Coronary artery	$∆$ Dense calcium mm³ (mean±SD); −0.2±5.4 treatment vs 0.1±1.8 control (P=0.746)	No significant attenuation of dense calcium
Longenecker 2016 ¹⁵	22	HIV infected	147	10 mg rosuvastatin daily	Placebo	Secondary	CT	Coronary artery	$∆$ CAC (%); 15% treatment vs 6% control (P=0.19)	No significant attenuation
Lo 2015 ⁵¹	12	HIV infected with subclinical coronary atherosclerosis	40	Stepwise escalation from 20 mg then 40 mg atorvastatin daily	Placebo	Secondary	CT	Coronary artery	$∆$ CAC mean Agatston score, median (IQR); 1.7 (0.0 to 28.0) treatment vs 0.9 (0.0 to 18.5) control (P=0.74)	No significant attenuation
Miyoshi 2018 ¹⁶	12	Hypercholesterolemia and CAC	156	Treatment A: 2 mg pitavastatin daily plus 1800 mg eicosapentenoic acid daily	2 mg pitavastatin daily	Primary	CT	Coronary artery	$∆$ CAC (%); 42% treatment A vs 34% control (P=0.88); 44% treatment B vs 34% control (P=0.80)	No significant attenuation
Miyoshi 2018 ¹⁶	12	Hypercholesterolemia and CAC	156	Treatment B: 4 mg pitavastatin daily	2 mg pitavastatin daily	Primary	CT	Coronary artery		No significant attenuation
Park 2016 ⁴⁹	12	Coronary artery disease	312	40 mg rosuvastatin daily	10 mg rosuvastatin daily	Primary	VH‐IVUS	Coronary artery	Difference in $∆$ dense calcium % (95% CI) between treatment vs control; 0.98 (3.25 to 1.27) (P=0.391)	No significant attenuation
Petri 2011 ¹⁷	24	SLE	200	40 mg atorvastatin daily	Placebo	Primary	CT	Coronary artery	$∆$ CAC log_e (95% CI) treatment minus control; −0.08 (−0.39 to 0.23) (P=0.62)	No significant attenuation
Plazak 2011 ¹⁸	12	SLE (CKD with CrCl <30 excluded)	60	40 mg atorvastatin daily	Placebo	Primary	CT	Coronary artery	Calcium score (Agatston); 32.1±39.1 to 59.5±64.4 (P<0.05) with control; 44.8±50.6 to 54.9±62.5 with treatment (P=n.s.)	Attenuation by statin compared with placebo
Raggi 2005 ¹⁹	12	Postmenopausal women aged 55–75 y, hypercholesterolemia, and presence of or at increased risk of coronary heart disease	615	80 mg atorvastatin daily	40 mg pravastatin daily	Primary	EBCT	Coronary artery	$∆$ Calcium volume score (% mean±SD); 20.1±30.8 treatment vs 19.8±34.8 control (P=0.64)	No significant attenuation
Schmermund 2006 ²⁰	12	Age 32–80 y, dyslipidemia and no history of ischemic heart disease	471	80 mg atorvastatin daily	10 mg atorvastatin daily	Primary	EBCT	Coronary artery	$∆$ CAC, % mean (95% CI); 27 (20.8 to 33.1) treatment, 25 (19.1 to 30.8) control (P=0.65)	No significant attenuation with higher dose statin
Terry 2007 ²¹	12	Age 21–75 y, dyslipidemia and presence of CAC. Diabetes excluded.	80	80 mg simvastatin daily	Placebo	Primary	CT	Coronary artery and abdominal aorta	$∆$ CAC; 9% treatment vs 5% control (P=0.12)	No significant attenuation

AU indicates Agatston units; CAC, coronary artery calcification; CKD, chronic kidney disease; CrCl, creatinine clearance; CT, computed tomography; EBCT, electron‐beam computed tomography; HMG‐CoA, 3‐hydroxy‐3‐methylglutaryl coenzyme A; IQR, interquartile range; n.s., not significant; OCT, optical coherence tomography; SLE, systemic lupus erythematosus; and VH‐IVUS, virtual histology intravascular ultrasound.