CIRC Research Project: Therapeutic Efficacy
Quantitative non-invasive cardiovascular imaging can serve as a powerful surrogate to evaluate therapeutic efficacy. Program investigators have pursued a multi-modality approach including PET, MR, and CT.

Statins to Prevent Cardiotoxicity from Anthracyclines
There is an increased risk for heart failure after anthracycline-based chemotherapy. The increased risk of heart failure after anthracyclines is due to an increase in myocardial fibrosis and a reduction in the left ventricular ejection fraction. In animal studies and preliminary human data, statins have been associated with a reduction in myocardial fibrosis and a higher LVEF. STOP-CA will test, in a randomized, double-blind, multi-center, placebo-controlled clinical trial whether statins at the time of anthracycline-based chemotherapy is associated with a reduction in myocardial fibrosis and preservation of the left ventricular ejection fraction using cardiac MRI.
Statins to prevent cardiovascular events and reduce coronary plaque in HIV
HIV infection doubles the risk of major adverse cardiovascular events, independent of traditional risk factors such as high cholesterol. Preliminary work by our group found that one year of atorvastatin can reduce coronary plaque as measured on CT in HIV. The ongoing REPRIEVE trial (n = 6,500) will test whether pitavastatin can prevent adverse cardiovascular events in HIV. REPRIEVE includes a mechanistic CT substudy (n = 800) which will determine the effect on coronary plaque using serial CT, and place these changes in the context of blood markers of immune activation and inflammation.
PET/CT for arterial inflammation
FDG PET/CT has been used extensively to characterize atherosclerotic plaque metabolism (an index of inflammatory activity). Program investigators have studied dozens of drug classes in the context of double-blind, placebo-controlled multi-center trials. Thus far, for all of the 5 drug classes for which there is both PET/CT and clinical event data, there has been concordance between change in imaging and reductions in outcomes. Accordingly, relatively small and swift imaging studies may facilitate the identification of the most promising drugs.