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Review
. 2024 Nov 1;31(11):1479-1495.
doi: 10.5551/jat.RV22024. Epub 2024 Aug 8.

Lipid-lowering Therapy and Coronary Plaque Regression

Yasushi Ueki  1 , Tadashi Itagaki  1 , Koichiro Kuwahara  1
Affiliations
Review

Lipid-lowering Therapy and Coronary Plaque Regression

Yasushi Ueki et al. J Atheroscler Thromb. .

Abstract

Lipid-lowering therapy plays a central role in reducing cardiovascular events. Over the past few decades, clinical trials utilizing several imaging techniques have consistently shown that lipid-lowering therapy can reduce the coronary plaque burden and improve plaque composition. Although intravascular ultrasound has been the most extensively used modality to assess plaque burden, other invasive modalities, such as optical coherence tomography and near-infrared spectroscopy, provide relevant data on plaque vulnerability, and computed tomography angiography detects both plaque volume and characteristics non-invasively. A large body of evidence supports the notion that reducing low-density lipoprotein cholesterol using statins combined with ezetimibe and proprotein convertase subtillisin/kexin type 9 inhibitors consistently shows improvements in plaque burden and favorable morphological changes. This review summarizes previously obtained data on the impact of lipid-lowering treatment strategies on atherosclerotic plaque regression, as assessed using several imaging modalities.

Keywords: Computed tomography; Intravascular ultrasound; Lipid-lowering therapy; Near-infrared spectroscopy; Optical coherence tomography; Plaque regression.

PubMed Disclaimer

Conflict of interest statement

Dr. Ueki reports grants from Astellas Pharma and personal fees from Abbott Vascular, Amgen, Bayer, Daiichi Sankyo, Kowa, NIPRO, and Novartis, outside the submitted work.

Dr. Kuwahara has received lecture fees from Astellas Pharma Inc., AstraZeneca K.K., MSD K.K., Otsuka Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Kyowa Kirin Co., Ltd., Kowa Co., Ltd., Sanofi K.K., Sumitomo Dainippon Pharma Co., Ltd. (Sumitomo Pharma Co., Ltd.), Mitsubishi Tanabe Pharma Corp., Eli Lilly Japan K.K., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K.K., Novo Nordisk Pharma Ltd., Bayer Yakuhin, Ltd., Pfizer Japan Inc., and Janssen Pharmaceutical K.K.; funded research or joint research expenses from Kowa Co., Ltd., AstraZeneca K.K., Daiichi Sankyo Co., Ltd., Novo Nordisk Pharma Ltd., Amgen, Janssen Pharmaceutical K.K., Parexel International Inc., and Astellas Pharma Inc. His affiliated institution (Shinshu University School of Medicine) has received grants from Otsuka Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corp., Nippon Boehringer Ingelheim Co., Ltd., and Kyowa Kirin Co., Ltd., and his department has endowed chairs from Medtronic Japan Co. Ltd., Boston Scientific Japan K.K., Abbott Japan LLC, Japan Lifeline Co.,Ltd., Biotronik Japan, Terumo Corporation, Nipro Corporation, and Cordis Japan G.K.

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Figures

Fig.1. Characteristics of imaging modalities for assessing coronary plaques.
Fig.1. Characteristics of imaging modalities for assessing coronary plaques.
CTA, computed tomography angiography; FCT, fibrous cap thickness; IVUS, intravascular ultrasound; LCBI, lipid core burden index; NA, not available; NIRS, near-infrared spectroscopy; OCT, optical coherence tomography; PAV, percent atheroma volume; TAV, total atheroma volume.
Fig.2. Correlation between plaque variables by intracoronary imaging and achieved LDL-C.
Fig.2. Correlation between plaque variables by intracoronary imaging and achieved LDL-C.
Bubble plot showing the change in the PAV (A), % change in the TAV (B), change in minimum FCT (C), and change in maxLCBI4mm (D) (y-axis) in comparison with the achieved LDL-C (x-axis) in the treatment arms of major plaque regression trials (control arms are not shown). The bubble size was proportional to the number of patients in the treatment arm. FCT, fibrous cap thickness; LCBI, lipid core burden index; LDL-C, low-density lipoprotein cholesterol; PAV, percent atheroma volume; TAV, total atheroma volume.
See this image and copyright information in PMC

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