Hey docs,
Any benefit in using statins with atherosclerotic disease in the absence hyperlipidemia?
I vaguely remember reading about statins improving endothelial function via NO increase along with a number of other functions but I’m not sure on their practical efficacy in CAD outside of lowering cholesterol.
thanks for your time
Yes, there are pleiotropic effects of statins with respect to endothelial function and other non-lipid-mediated processes.
Additionally - I would want to know how the atherosclerotic disease was diagnosed (e.g., CAC/coronary CTA/left heart catheterization vs. stress test vs. true clinical event, etc.), how the absence of hyperlipidemia had been identified, and whether a serum apoB or Lp(a) level had been measured.
Let’s say in this purely hypothetical patient, with a medical history significant only for CAD and tobacco use, had a CAC score slightly greater than 300 a few months back, CAC test was brought on due to CT abd/p showing aortic calcification. Cardiac workup (including stress test, echocardiogram and EKG) was unremarkable. Lipid panel showed HDL, LDL, triglycerides and total cholesterol all within normal limits. Serum lipoproteins levels and CCTA have never been done however.
Would these factors change the plan of care regarding statins?
Lifestyle interventions - in particular tobacco cessation if still actively smoking - will be most important here, as always.
Statin use would still allow further risk reduction beyond lifestyle interventions alone in this individual. These meds would provide an approximately 20-30% relative risk reduction. Whether the absolute risk reduction is worthwhile/desirable for the individual would require an estimation of their risk using an established risk model – ideally one that includes the CAC like the MESA risk score, although the caveat is that this only projects 10-year risk. I would also consider a one-time measurement of Lp(a).
Thanks for the info Austin. Appreciate all that you guys do