Improved plaque composition from intensive medical treatment in women with angina and non-obstructive coronary disease

Abstract

Abstract Aims Among women with suspected ischaemia and non-obstructive coronary artery disease (INOCA), the temporal effect of combination intensive medical treatment (IMT) with angiotensin-converting enzyme inhibitors or receptor blockers, statins, and aspirin on coronary plaque composition is not known. This prospective ancillary study examined changes in atherosclerotic plaque volumes and composition (percentage of total plaque volume) over time between IMT and usual care (UC). Methods and results Participants from the randomized WARRIOR trial with the presence of plaque on their first coronary computed tomography angiography (CCTA) were enrolled for a follow-up CCTA at least 2 years after randomization. Volumes and volumetric composition (percentage of total plaque volume) of non-calcified plaque (NCP), low-density NCP (LD-NCP, defined as NCP <30 HU), and calcified plaque (CP) were quantified over the coronary tree in the serial scans. Participants (n = 186) completed both scans with good image quality (94 IMT arm and 92 UC arm). Overall mean age was 61.0 years (SD ±10.9), and there were no statistically significant differences in baseline risk factors, plaque volumes, or statin treatment between the arms. There was a greater bi-annualized increase in CP volume [ΔCP volume (mm3)] in the IMT arm, 6.2 (SD ±15.5) compared to the UC arm, 3.9 (SD ±16.0), P = 0.013, and a consistent greater reduction in NCP composition [ΔNCP composition (%)] in the IMT arm, −3.9 (SD ±7.7) compared to the UC arm, −1.5 (SD ±5.8), P = 0.003, with no increase in total plaque volume. Conclusion In women with suspected INOCA, IMT reduces NCP volumetric composition to a greater extent than UC and may promote plaque stabilization.