# Effect of Intensive Medical Treatment on Quantified Coronary Artery Plaque Components with Serial Coronary CTA in Women with Non-Obstructive CAD

> **NIH NIH R01** · CEDARS-SINAI MEDICAL CENTER · 2020 · $406,589

## Abstract

ABSTRACT
Cardiovascular disease is the leading cause of mortality among women. Among symptomatic
women presenting to coronary angiography, 40-65% have no obstructive coronary artery disease
(CAD). Considered low risk, they often receive no specific therapy. Yet, evidence now documents
that such women have higher than expected risk for major adverse cardiac events. The
WARRIOR trial is a multicenter, prospective, randomized, blinded outcome evaluation evaluating
intensive medical therapy (IMT) with aspirin, statin, angiotensin converting enzyme inhibitor
(ACEI) and/or angiotensin receptor blocker (ARB) vs. usual care (UC) in 4,422 women with
ischemic symptoms and non- obstructive CAD. The hypothesis of WARRIOR is that IMT will
reduce major adverse cardiac events including angina and hospitalization. We hypothesize that
the beneficial effects of IMT may be due to changes in plaque composition and flow reserve
related to endothelial and microvascular dysfunction rather than from reduction in stenosis
severity. Coronary computed tomographic (CT) angiography (CTA) can identify high-risk plaque
features associated with endothelial dysfunction and myocardial ischemia. Recent studies have
shown that plaque inflammation inhibits adipocyte maturation in pericoronary artery adipose
tissue (PCAT) and in turn increases the density of PCAT. Thus, quantitative CTA can potentially
allow a comprehensive noninvasive evaluation of changes in plaque burden, coronary flow and
plaque inflammation. We have developed validated software for quantitative characterization of
plaque and PCAT density using CTA. In this ancillary substudy, we will recruit 400 patients from
the WARRIOR trial with 200 patients from each of the treatment groups (IMT vs UC). From this
cohort, 150 patients per treatment group, most compliant with WARRIOR protocol will undergo a
CTA at the end of 3 years; with changes in plaque and PCAT characteristics quantified. We
propose 3 aims: (1) To compare changes in coronary plaque characteristics and their
hemodynamic significance using CTA in WARRIOR women treated with IMT vs UC; (2) To
compare changes in plaque inflammation-related characteristics in PCAT in WARRIOR women
treated with IMT with statin in combination with angiotensin converting enzyme inhibitor (ACEI)
and/or angiotensin receptor blocker (ARB) medications vs UC; (3) To relate plaque burden and
plaque composition, CT flow reserve, and PCAT density changes to angina score (Seattle Angina
Questionnaire [SAQ]) changes in IMT and UC-randomized WARRIOR women. Our study will be
the first to quantify the impact of IMT on plaque composition and inflammation and its relation to
clinical improvement in women with ischemic symptoms and nonobstructive CAD.

## Key facts

- **NIH application ID:** 9924375
- **Project number:** 1R01HL151266-01
- **Recipient organization:** CEDARS-SINAI MEDICAL CENTER
- **Principal Investigator:** Damini Dey
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $406,589
- **Award type:** 1
- **Project period:** 2020-09-01 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9924375

## Citation

> US National Institutes of Health, RePORTER application 9924375, Effect of Intensive Medical Treatment on Quantified Coronary Artery Plaque Components with Serial Coronary CTA in Women with Non-Obstructive CAD (1R01HL151266-01). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9924375. Licensed CC0.

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