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Multicenter Study
. 2026 Feb;115(2):208-219.
doi: 10.1007/s00392-024-02502-6. Epub 2024 Jul 30.

Effects of high- versus low-intensity lipid-lowering treatment in patients undergoing serial coronary computed tomography angiography: results of the multi-center LOCATE study

Loris Weichsel  1   2 , Florian André  3   4   5 , Matthias Renker  6   7 , Philipp Breitbart  8 , Daniel Overhoff  9 , Meinrad Beer  10 , Alexander Giesen  1   2 , Borbála Vattay  11 , Sebastian Buss  5 , Mohamed Marwan  12 , Christopher L Schlett  13 , Andreas A Giannopoulos  14 , Sebastian Kelle  15   16 , Norbert Frey  3   4 , Grigorios Korosoglou  17   18 ; LOCATE Investigators
Collaborators, Affiliations
Multicenter Study

Effects of high- versus low-intensity lipid-lowering treatment in patients undergoing serial coronary computed tomography angiography: results of the multi-center LOCATE study

Loris Weichsel et al. Clin Res Cardiol. 2026 Feb.

Abstract

Aim: To evaluate the effects of lipid-lowering medications of different intensities on total, calcified, and non-calcified plaque volumes in patients undergoing serial cardiac computed tomography angiography (CCTA).

Methods: Individuals with chronic coronary syndromes from 11 centers were included in a retrospective registry. Total, calcified, and non-calcified plaque volumes were quantified and the relative difference in plaque volumes between baseline and follow-up CCTA was calculated. The intensity of lipid-lowering treatment was designated as low, moderate, or high, based on current recommendations.

Results: Of 216 patients (mean age 63.1 ± 9.7 years), undergoing serial CCTA (median timespan = 824.5 [IQR = 463.0-1323.0] days), 89 (41.2%) received no or low-intensity lipid-lowering medications, and 80 (37.0%) and 47 (21.8%) moderate- and high-intensity lipid-lowering agents, respectively. Progression of total and non-calcified plaque was attenuated in patients on moderate-/high- versus those on no/low-intensity treatment and arrested in patients treated with high-intensity statins or PCSK9 inhibitors (p < 0.001). Halted increase of non-calcified plaque was associated with LDL-cholesterol reduction (p < 0.001), whereas calcified plaque mass and Agatston score increased irrespective of the lipid-lowering treatment (p = NS). The intensity of lipid-lowering therapy robustly predicted attenuation of non-calcified plaque progression as a function of the time duration between the two CCTA scans, and this was independent of age and cardiovascular risk factors (HR = 3.83, 95% CI = 1.81-8.05, p < 0.001).

Conclusion: The LOCATE multi-center observational study shows that progression of non-calcified plaques, which have been previously described as precursors of acute coronary syndromes, can be attenuated with moderate-intensity, and arrested with high-intensity lipid-lowering therapy.

German clinical trials register: DRKS00031954.

Keywords: Agatston score; Atherosclerosis; Coronary artery disease; Low/high intensity lipid-lowering treatment; Multi-center; Non-calcified plaque; Serial plaque quantification.

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Conflict of interest statement

Declarations. Conflict of interest: GK: received modest honoraria from Philips Healthcare, Siemens Healthineers, Cordis, Boston scientific and BARD Peripheral Vascular Inc., and institutional grants from Philips Healthcare and Bard Peripheral Vascular Inc. NF: received speaker fees from Daiichi Sankyo, Novartis, and Pfizer. SK: received an unrestricted grant from Philips Healthcare, Siemens as well as GE and was supported by the German Federal Ministry of Education and Research and the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)-CRC-1470-B06. MR: received proctor fees from Boston Scientific. DO: received speaker fees from Canon medical. P.B: receives speaker honoraria and consultancy fees from AstraZeneca, Daiichi Sankyo, Novo Nordisk, and Sanofi Aventis. M.W: received speaker honoraria Edwards lifescience and Siemens healthineers and a research Grant from the 'Deutsche Herzstiftung'.

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