Impact of coronary artery calcification on statin therapy and major adverse cardiovascular events
WU Di
YU Dan-qing
Abstract：Background Coronary artery calcification (CAC), a hallmark of atherosclerosis, paradoxically associates with reduced cardiovascular risk under statin therapy despite accelerated calcification progression, prompting this study to explore CAC metrics as potential mediators between statin use and major adverse cardiovascular events (MACE). Methods Clinical data of 246 hospitalized patients who underwent coronary computed tomography angiography (CCTA) at Guangdong Provincial People's Hospital from January 2023 to June 2023 were retrospectively analyzed. Linear regression was used to evaluate the relationship between statin use and CAC parameters. Multi-variable Poisson regression models were applied to explore the associations of statin use and CAC parameters with MACE risk. A mediation analysis was performed to assess the role of CAC parameters in the statin-MACE relationship. Results Statin use was independently associated with increased calcification score (β=0.648, P<0.001), CAC volume (β=0.623, P<0.001), and calcified plaque proportion (β=0.606, P=0.002). Multivariable Poisson regression indicated that statin use significantly reduced MACE risk [incidence rate ratio (IRR): 0.33, P=0.018], whereas calcification score (IRR: 2.63, P=0.026) and CAC volume (IRR: 2.66, P=0.044) were associated with elevated MACE risk; Calcified plaque proportion showed no significant association. Mediation analysis revealed that calcification score (β=0.035, P=0.021) and CAC volume (β=0.023, P=0.018) exerted masking effects, while calcified plaque proportion had no mediating role. Conclusions Calcification score and CAC volume demonstrated limited masking effects in the association between statin use and MACE.
Keywords：Coronary artery calcificationStatinsMajor adverse cardiovascular eventsMediation analysis
Publication Date：2025-06-30
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：10( 78-87 )