Impact of Intensive Low-Density Lipoprotein Cholesterol-Lowering Therapy on Coronary Artery Plaques in Acute Coronary Syndrome

• Published in: The American journal of cardiology 2023-10, Vol.204, p.84-91
• Main Authors: Hirai, Keisuke, Kawasaki, Tomohiro, Soejima, Toshiya, Kajiyama, Kimihiro, Fukami, Yurie, Asada, Satoshi, Haraguchi, Kazuki, Fukuoka, Ryota, Orita, Yoshiya, Umeji, Kyoko, Koga, Hisashi, Yamabe, Hiroshige
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Angina pectoris; Angiography; Arteries; Atherosclerosis; Attenuation; Blood pressure; Body mass index; Cholesterol; Computed tomography; Coronary artery; coronary artery plaque; coronary computed tomography angiography; Coronary vessels; Density; Diabetes; Heart attacks; Hyperlipidemia; Hypertension; lipid lowering therapy; Lipids; Low density lipoprotein; Morphology; Patients; Plaques; Population studies; Risk groups; Software; Tomography; Veins & arteries
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2023.07.049

Acute coronary syndrome (ACS) is associated with a high incidence of unstable plaques beyond the culprit lesion, leading to early recurrence of cardiovascular events. Coronary computed tomography angiography (CCTA) can be used to non-invasively observe plaques throughout the coronary arteries. To evaluate the impact of intensive low-density lipoprotein cholesterol (LDL-C)-lowering therapy on quantitative changes in coronary plaque, assessed using CCTA in a study population with ACS. Eighty-one consecutive patients with ACS who underwent CCTA at discharge and at 1-year follow-up from April 2018 to March 2020 were analyzed. The patients were divided into two groups: those who achieved LDL-C < 70 mg/dl and those who did not. Changes in plaque morphology within and between the two groups were compared using CCTA. A total of 198 vessels were analyzed. The calcified plaque volume was significantly increased in the LDL-C < 70 group (65.8 ± 80.1 mm3 to 73.6 ± 83.7 mm3, p = 0.007), while no significant change was observed in the LDL-C ≥ 70 group (106.9 ± 161.7 mm3 to 105.7 ± 137.5 mm3, p = 0.552). Percent change in low-attenuation plaque (LAP) volume in LDL < 70 group was significantly lower than in the LDL-C ≥ 70 group (17.2 ± 90.9% versus 84.4 ± 162.6%, p = 0.020). Receiver operating characteristic curve analysis demonstrated that the target LDL-C level for LAP volume regression was 64 mg/dl. In conclusion, noninvasive CCTA demonstrated that intensive LDL-C lowering in high-risk patients with ACS could potentially lead to plaque stabilization.