The effects of lipid-lowering therapy on coronary plaque regression: a systematic review and meta-analysis

Abstract

To assess the influence of lipid-lowering therapy on coronary plaque volume, and to identify the LDL and HDL targets for plaque regression to provide a comprehensive overview. The databases searched (from inception to 15 July 2020) to identify prospective studies investigating the impact of lipid-lowering therapy on coronary plaque volume and including quantitative measurement of plaque volume by intravascular ultrasound after treatment. Thirty-one studies that included 4997 patients were selected in the final analysis. Patients had significantly lower TAV (SMD: 0.123 mm3; 95% CI 0.059, 0.187; P = 0.000) and PAV (SMD: 0.123%; 95% CI 0.035, 0.212; P = 0.006) at follow-up. According to the subgroup analyses, TAV was significantly reduced in the LDL < 80 mg/dL and HDL > 45 mg/dL group (SMD: 0.163 mm3; 95% CI 0.092, 0.234; P = 0.000), and PAV was significantly reduced in the LDL < 90 mg/dL and HDL > 45 mg/dL group (SMD: 0.186%; 95% CI 0.081, 0.291; P = 0.001).Thirty-one studies that included 4997 patients were selected in the final analysis. Patients had significantly lower TAV (SMD: 0.123 mm3; 95% CI 0.059, 0.187; P = 0.000) and PAV (SMD: 0.123%; 95% CI 0.035, 0.212; P = 0.006) at follow-up. According to the subgroup analyses, TAV was significantly reduced in the LDL < 80 mg/dL and HDL > 45 mg/dL group (SMD: 0.163 mm3; 95% CI 0.092, 0.234; P = 0.000), and PAV was significantly reduced in the LDL < 90 mg/dL and HDL > 45 mg/dL group (SMD: 0.186%; 95% CI 0.081, 0.291; P = 0.001). Our meta-analysis suggests that not only should LDL be reduced to a target level of < 80 mg/dL, but HDL should be increased to a target level of > 45 mg/dL to regress coronary plaques.Trial Registration PROSPERO identifier: CRD42019146170.

Atherosclerotic coronary plaque regression from lipid-lowering therapies: A meta-analysis and meta-regression

“…Previously published pooled analyses have established the role of LLTs on plaque regression [70] , [71] , [72] , [73] . However, most pooled analysis to date were rather conservative in the type of LLT included and did not account for the level of lipids at follow-up.…”

There is urgent need to treat atherosclerotic cardiovascular disease risk earlier, more intensively, and with greater precision: A review of current practice and recommendations for improved effectiveness

“… Plaque Significant enhancing factors Established ASCVD. Studies have shown that reversal of plaque begins when LDL-C falls below approximately 60–80 mg/dl and treatment is begun before significant scarring and calcification occurs [246] , [247] , [248] . That should also make new intimal thickening, plaque and intraarterial thrombi much less likely, if blood pressure and all other factors are well controlled.…”

Small interfering ribonucleic acid for cholesterol lowering – Inclisiran

“…5 Intravascular ultrasound evidence suggests that plaque regression occurs when LDL-C is lowered to < 70-80 mg/dL. 6 Moreover, studies of individuals with genetic variants in genes encoding proteins that regulate LDL-C levels have revealed that the strength of the relationship between LDL-C and cardiovascular risk is time dependent. 3 For example, people with a loss-of-function variant in the gene encoding for PCSK9, such as a nonsense mutation, that results in a reduction in LDL-C have up to an 88% lower risk of CHD (myocardial infarction, fatal CHD, or coronary revascularization) because lower LDL-C is present since birth.…”