Published in Cardiology

Journal Scan / Research · April 20, 2017

Impact of Intensive LDL Cholesterol Lowering on Coronary Artery Atherosclerosis Progression

JACC: Cardiovascular Imaging

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• This study used coronary computed tomography angiography (CTA) to determine the association of temporal changes in coronary plaque volume with intensity of lipid-lowering treatments. Elevated LDL-C levels (≥70 mg/dl) were associated with increased plaque progression over the median 3.2-year follow-up.

• The results indicate that intensive LDL-C control improves plaque volume and may provide greater benefit than less strict LDL-C control in patients with atherosclerosis.

Abstract

This abstract is available on the publisher's site.

OBJECTIVES

The aim of this study was to explore the relationship between temporal changes in coronary plaque volume and the intensity of lipid-lowering treatments, utilizing coronary computed tomography angiography (CTA).

BACKGROUND

Coronary CTA has acceptable accuracy in terms of quantitative measurement of plaque volume. Although, coronary CTA is perhaps capable of identifying the differences in plaque volume progression according to the intensity of lipid lowering treatment, to date, few studies have examined this notion.

METHODS

In this multicenter, observational study, the authors reviewed 467 patients who underwent serial coronary CTA with a scan period of more than 2 years (median 3.2 years [2.4 to 4.8]) apart, and whose laboratory data were available within 1 month of both the baseline and follow-up coronary CTA. Among them, 147 patients (comprising 336 vessels) with visible plaque were enrolled in this study. The authors performed quantitative assessment of coronary plaque in both. Patients who achieved a low-density lipoprotein cholesterol (LDL-C) with a cut off value below 70 mg/dl at follow-up were compared with those who did not.

RESULTS

Patients with LDL-C below 70 mg/dl displayed a significant attenuation in plaque progression as compared with those with follow-up LDL-C levels ≥70 mg/dl (12.7 ± 38.2 mm(3) vs. 44.2 ± 73.6 mm(3), respectively; p = 0.014). In multivariate analysis, factors influencing plaque progression per year was follow-up LDL-C levels ≥70 mg/dl (beta 0.193; p = 0.021).

CONCLUSIONS

Strict LDL-C control appeared to significantly attenuate plaque volume progression based on noninvasive quantitative assessment by coronary CTA.