Statin Use Slowed Progression of Arterial Stiffness in High-risk Patients Followed for Nearly 5 Years

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In a large cohort of adults at high atherosclerotic risk, use of statin therapy was associated with significantly lower baseline arterial stiffness as well significantly slower progression of this independent predictor of cardiovascular (CV) risk and mortality.

Chinese investigators found that, on average, study participants treated with statins had a baseline brachial-ankle pulse wave velocity (baPWV) that was 33.6 centimeters per second (cm/s) slower than non-statin users and, in addition, that progression of baPWV level among statin users was 23.3 cm/s per year slower than for nonusers.

The authors, publishing recently in JAMA Network Open, say, “to our knowledge, this is the largest and longest study assessing the association between statin use and arterial stiffness” in this high-risk group of adults.

As context for their research, the authors, led by Shouling Wu, MD, from the department of cardiology at Kailuan Hospital, North China University of Science and Technology, in Tangshan, China, write that prior studies have yielded mixed findings regarding the association and have been of inconsistent design, with findings limited by relatively small sample sizes and short follow-up periods. Moreover, no study has looked specifically at the association between statin use and progression of arterial stiffness.

For their retrospective cohort analysis, Wu and colleagues drew on electronic medical records from the Kailuan General Hospital for patients treated from 2010-2020. The analysis was specifically designed to include a larger cohort than previous studies and a follow-up of nearly 5 years.

Beginning in 2010, patients identified as at higher risk for peripheral arterial disease (PAD), ie, those with at least 1 risk factor (hypertension, diabetes, dyslipidemia, obesity, or metabolic syndrome) were invited to undergo vascular health assessments, which included baPWV measurements.

From an original group of 13 563 participants, 5105 adults were included in the analysis of statin use and baseline baPWV. For the analysis of statin use and baPWV progression, the researchers excluded an additional group 1502 participants in the cohort used for that final analysis.

Baseline baPWV

Among the 5105 participants with baseline baPWV assessment, the mean age was 60.8 (SD, 9.7) years and 75.3% were men. After propensity score matching for statin use, 2620 (1310 each in the statin and non-statin use groups) were compared. Wu et al found that, statin users had a significantly lower baPWV at baseline than nonusers (difference -33.6 cm/s [95% CI, -62.1 to -5.1]).

Progression of atherosclerosis

From the 1502 participants with repeated baPWV assessments, investigators matched 410 statin users with 410 nonusers for comparison of progression. They report that over a mean follow-up of 4.8 (SD, 2.7) years, progression of baPWV among statin-treated patients was significantly slower (difference, -23.3 cm/s per year [95% CI, -40.6 to -6.0]) than among nonusers.

Further analysis of patient subgroups within these cohorts demonstrated a significantly slower progression of baPWV in continuous statin users (difference, -24.2 cm/s per year [95% CI, -42.2 to -6.3]) and highly adherent users (difference, -39.7 cm/s per year [95% CI, -66.9 to -12.4]) when compared to nonusers.

The investigators write, however, that this trend was not observed when they compared those who discontinued statin use (difference, -17.3 cm/s per year [95% CI, -52.4 to 17.8]) and those whose treatment adherence was low (difference, -17.9 cm/s per year [95% CI, -36.5 to 0.7]) to participants not using statins.

“This retrospective cohort study found that statin use is associated with slowing the progression of baPWV among adults with high atherosclerotic risk, especially among patients who continuously take statins and have high adherence. These findings suggest that statin use provides a substantial potential in preventing the development and worsening of subclinical cardiovascular lesions at an early stage,” investigators wrote.

Reference: Zhou Y-F, Wang Y, Want G, et al. Association between statin use and progression of artieral stiffness among adults with high atherosclerotic risk. JAMA Network Open. 2022;5:e2218323. doi:10.1001/jamanetworkopen.2022.18323