The Role of Aggressive Lipid Lowering Therapy for Coronary Artery Disease

Abstract

Atherosclerotic cardiovascular disease is the leading cause of death worldwide. Among the most promising results of the preventing approach against progression of atherosclerosis derived from lipid lowering therapy especially by statins. Recent clinical trials with statins indicated that aggressive lipid lowering therapy could inhibit the progression of atherosclerosis or even induce the regression of atherosclerotic plaque. It also stabilizes the unstable plaque to stable form and reduces clinical CV events.Several trials using intravascular ultrasound demonstrated that lowering LDL-C to 70-80 mg/dl by aggressive lipid-lowering treatment with moderately high-dose statins significantly reduced coronary plaque volume, but these studies are vastly underpowered to determine the effects of such lipid-lowering treatment on clinical outcomes. Accordingly, the value of reducing LDL-C levels substantially below 100 mg/dl in patients with CAD, particularly Asian patients, had not been clearly demonstrated, and Japanese guidelines recommended reducing LDL-C only to immediately below 100 mg/dl until recently. HIJ-PROPER and REAL-CAD provided pivotal evidence for the aggressive lipid-lowering in Japanese patients at secondary prevention. The lipid management strategy for secondary prevention is still changing in clinical practice from recent Japanese evidence.In this article, we will review the history and current understanding of the efficacy of aggressive lipid lowering therapy which inhibits the atherosclerosis progression and induces the regression, and we also will review the recent clinical evidence especially from Japan.