Statin Therapy in HIGH-Risk Individuals with NORMal Coronary Arteries: The HIGH-NORM Study

Kyeong Hyeon Chun, Jung Mi Park, Chan Joo Lee, Jaewon Oh, Sungha Park, Seok Min Kang, Sang Hak Lee

Research output: Contribution to journalArticlepeer-review


Aims: Mismatches between the risk status of a patient and coronary imaging data can lead to conflicting strategies to prevent a cardiovascular event. We evaluated whether statin use was associated with cardiovascular benefit in high-risk individuals whose coronary computed tomography angiography (CCTA) results showed normal coronary arteries. Methods: Among asymptomatic individuals whose CCTA showed normal or near normal coronary arteries, 3,389 persons with high-or very-high-risk status were included in this retrospective study. After 1:2 propensity score matching, 906 individuals (302 new statin users and 604 controls; mean age 61 years; male 58%) were analysed. The primary outcome variable was major adverse cardiovascular and cerebrovascular events (MACCEs) that consisted of cardiovascular death, nonfatal myocardial infarction, coronary revascularisation, and nonfatal ischemic stroke. Results: At a median follow-up of 5.8 years, 20 statin users and 17 controls (7.4 and 5.6 events/1,000 person-year, respectively; hazard ratio [HR) 1.04; p =0.92) experienced MACCE. Kaplan–Meier curves showed similar MACCE rates in both groups (p=0.91). In separate analyses for persons with normal (p =0.29) or near normal coronary arteries (p =0.67), MACCE rates did not differ between the groups. Age (HR 1.04; p=0.044), male sex (HR 3.06, p=0.018), and smoking (HR 2.87, p =0.019) were independently associated with MACCEs. In subgroup analyses, no significant factors affected the relationship between statin use and MACCEs. Conclusions: Statin use was not associated with cardiovascular risk reduction in high-risk persons with normal or near normal coronary arteries. More individualised lipid-lowering therapy may benefit this population.

Original languageEnglish
Pages (from-to)1085-1094
Number of pages10
JournalJournal of atherosclerosis and thrombosis
Issue number7
Publication statusPublished - 2022

Bibliographical note

Funding Information:
This work was supported by the National Research Foundation of Korea, funded by the Korean government (grant no. 2019R1F1A1057952). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Publisher Copyright:
© 2022 Japan Atherosclerosis Society.

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine
  • Biochemistry, medical


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