Abstract 12657: Clinical, Laboratory, and Coronary Plaque Predictors of Atherosclerotic Non-Response to Statin Therapy
Bibliographic record
Abstract
Introduction: Statins reduce major cardiovascular events, but residual risk remains. The study examined determinants of atherosclerotic statin non-response in patients using statins. Hypothesis: We hypothesized that a comprehensive evaluation of atherosclerosis identifies patients that progress atherosclerosis despite the use of statin therapy. Methods: The multi-center PARADIGM registry included patients who underwent serial CCTA ≥2 years apart, with whole-heart coronary tree quantification of vessel, lumen and plaque, and matching of baseline and follow-up coronary segments and lesions. Patients with statin use at baseline and follow-up CCTA were included. Atherosclerotic statin non-response was defined as an absolute increase in percent atheroma volume (PAV) of 1.0% or more per year. A secondary endpoint was defined by the additional requirement of progression of low-attenuation plaque or fibro-fatty plaque. Results: We included 649 patients (62.0±9.0 years, 63.5% male) on statin therapy and 205 (31.5%) experienced atherosclerotic statin non-response. Age, diabetes, hypertension, and all atherosclerotic plaque features (high risk plaque [HRP] features, calcified and noncalcified PAV, and lumen volume) were significantly different between patients with and without atherosclerotic statin non response, while only diabetes, the number of high risk plaque features, noncalcified and calcified PAV were independently associated with atherosclerotic statin non-response (OR:1.41 (0.95-2.11), OR:1.15 (1.09-1.21), OR:1.06 (1.02-1.10), OR:1.07 (1.03-1.12), respectively). For the secondary endpoint (N=125, 19.2%), only non-calcified PAV and number of HRP features were the independent determinants (OR:1.08 (1.03-1.13) and OR:1.21 (1.06-1.21), respectively). Conclusions: In patients treated with statins, baseline plaque characterization by plaque burden and high risk plaque is associated with atherosclerotic statin non-response defined as important progression of coronary atherosclerosis. Patients with the highest plaque burden including HRP were at highest risk for plaque progression, despite statin therapy. These patients may need additional therapies for further risk reduction.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".