Intensive medical therapy shifts coronary plaque composition in women with suspected INOCA

A prospective ancillary study of the randomized WARRIOR trial examined coronary plaque changes in women with suspected ischaemia and non-obstructive coronary artery disease (INOCA). Intensive medical treatment combined an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, a statin, and aspirin. Women with plaque on their initial coronary CT angiography underwent repeat imaging at least two years after randomization. Paired scans of adequate quality were available for 186 participants: 94 receiving intensive treatment and 92 receiving usual care.

Mean age was 61.0 years. Baseline risk factors, plaque volumes, and statin treatment did not differ significantly between groups. The reported bi-annualized increase in calcified plaque volume was greater with intensive treatment than usual care: 6.2 versus 3.9 mm³ (P = 0.013). Non-calcified plaque’s share of total plaque volume decreased by 3.9 versus 1.5 percentage points, respectively (P = 0.003), with no increase in total plaque volume reported.

These findings suggest that intensive treatment may promote plaque stabilization through changes in composition rather than reduced overall plaque burden. However, this analysis involved a selected imaging subset of the parent trial and assessed surrogate endpoints. The supplied abstract does not report clinical event outcomes, and full-text methods and limitations were unavailable for assessment.