scholarly journals The effects of lipid-lowering therapy on coronary plaque regression: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yingrui Li ◽  
Songbai Deng ◽  
Bin Liu ◽  
Yulin Yan ◽  
Jianlin Du ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Final Analysis ◽  
Coronary Plaque ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Target Level ◽  
Plaque Volume ◽  
Lowering Therapy ◽  
Plaque Regression

AbstractTo assess the influence of lipid-lowering therapy on coronary plaque volume, and to identify the LDL and HDL targets for plaque regression to provide a comprehensive overview. The databases searched (from inception to 15 July 2020) to identify prospective studies investigating the impact of lipid-lowering therapy on coronary plaque volume and including quantitative measurement of plaque volume by intravascular ultrasound after treatment. Thirty-one studies that included 4997 patients were selected in the final analysis. Patients had significantly lower TAV (SMD: 0.123 mm3; 95% CI 0.059, 0.187; P = 0.000) and PAV (SMD: 0.123%; 95% CI 0.035, 0.212; P = 0.006) at follow-up. According to the subgroup analyses, TAV was significantly reduced in the LDL < 80 mg/dL and HDL > 45 mg/dL group (SMD: 0.163 mm3; 95% CI 0.092, 0.234; P = 0.000), and PAV was significantly reduced in the LDL < 90 mg/dL and HDL > 45 mg/dL group (SMD: 0.186%; 95% CI 0.081, 0.291; P = 0.001).Thirty-one studies that included 4997 patients were selected in the final analysis. Patients had significantly lower TAV (SMD: 0.123 mm3; 95% CI 0.059, 0.187; P = 0.000) and PAV (SMD: 0.123%; 95% CI 0.035, 0.212; P = 0.006) at follow-up. According to the subgroup analyses, TAV was significantly reduced in the LDL < 80 mg/dL and HDL > 45 mg/dL group (SMD: 0.163 mm3; 95% CI 0.092, 0.234; P = 0.000), and PAV was significantly reduced in the LDL < 90 mg/dL and HDL > 45 mg/dL group (SMD: 0.186%; 95% CI 0.081, 0.291; P = 0.001). Our meta-analysis suggests that not only should LDL be reduced to a target level of < 80 mg/dL, but HDL should be increased to a target level of > 45 mg/dL to regress coronary plaques.Trial Registration PROSPERO identifier: CRD42019146170.

Abstract 12007: Combination Therapy of Eicosapentaenoic Acid and Pitavastatin for Coronary Plaque Regression Evaluated by Integrated Backscatter Intravascular Ultrasonography: A Randomized Controlled Trial

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kaoru Ando ◽  
Tetsu Watanabe ◽  
Hyuma Daidoji ◽  
Yoichiro Otaki ◽  
Naoto Hashimoto ◽  
...  
Keyword(s):  
Coronary Plaque ◽  
Lipid Lowering ◽  
High Dose ◽  
Lipid Lowering Therapy ◽  
Intravascular Ultrasonography ◽  
Plaque Volume ◽  
Lowering Therapy ◽  
Plaque Regression ◽  
Coronary Plaque Volume

Introduction: High intensity statin therapy is established for secondary prevention of coronary heart disease (CHD). However, additional therapy is required to reduce residual risk in CHD patients with aggressive lipid-lowering therapy. Eicosapentaenoic acid (EPA) was reported to be beneficial especially in secondary prevention. The aim of this study was to investigate whether coronary plaque regression and stabilization are reinforced by additional administration of EPA to high dose pitavastatin (PTV) therapy. Methods: We enrolled 200 CHD patients who underwent percutaneous coronary intervention in 6 hospitals. Patients were randomly allocated to PTV group (PTV 4 mg/day, n=98) and PTV/EPA group (PTV 4 mg/day and EPA 1800 mg/day, n=102), and prospectively followed for 6 to 8 months. Coronary plaque volume and composition in non-stenting lesion were analyzed by integrated backscatter intravascular ultrasonography at baseline and follow up. Results: EPA / arachidonic acid (AA) ratio was significantly increased in PTV/EPA group compared to PTV group at follow up period. Plaque volume and lipid volume were significantly reduced in PTV/EPA group, but not PTV group. There was a significant inverse correlation between change in EPA/AA ratio and changes in plaque volume (r=-0.332, p<0.001). Plaque regression was defined as percent change in plaque volume more than -14.6% according to previous reports. A multivariate logistic analysis demonstrated that the additional administration of EPA was independently associated with plaque regression after adjustment of confounding factors. The prevalence rate of plaque regression was significantly higher in PTV/EPA group than in PTV group (50% vs. 24%, p<0.001). Conclusions: Additional administration of EPA to high dose PTV therapy significantly reduced coronary plaque volume, suggesting that combination therapy of EPA and PTV might reduce residual risk in CHD patients with aggressive lipid-lowering therapy.

Non-statin lipid-lowering therapy in coronary atherosclerosis regression: a meta-analysis and meta-regression

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L.M Lobo ◽  
G Molinero ◽  
W Masson ◽  
D Siniawski ◽  
G Masson ◽  
...  
Keyword(s):  
Coronary Atherosclerosis ◽  
Meta Analysis ◽  
Lipid Lowering ◽  
Forest Plot ◽  
Lipid Lowering Therapy ◽  
Pcsk9 Inhibitors ◽  
Lowering Therapy ◽  
Meta Regression ◽  
Statin Drugs

Abstract Introduction Several studies have investigated the association between non-statin lipid-lowering therapy and regression of atherosclerosis. However, the studies were mostly small and their results were not always robust. Objectives (1) to define if a dual lipid-lowering therapy (statin ± non-statin drugs) is associated with coronary atherosclerosis regression, estimated by intravascular ultrasound (IVUS); (2) to assess the association between dual lipid-lowering-induced changes in LDL-C and non-HDL-C levels and atherosclerosis regression. Methods We performed a meta-analysis including trials of non-statin lipid-lowering therapy, reporting C-LDL, non-HDL-C and total atheroma volume (TAV) with a minimum of 6 months of follow-up. The primary endpoint was defined as the change in TAV measured from baseline to follow-up, comparing groups of subjects on statins alone versus combination of statin and non-statin drugs. The random-effects model and meta-regression were performed. Results Eight eligible trials of non-statin lipid-lowering drugs (1759 patients) were included. Overall, the dual lipid-lowering therapy was associated with a significant reduction in TAV [−3.5 mm3 (95% CI: −4.5 to −2.6)]; I2=11%]. In the analysis stratified according to the lipid-lowering drug class (ezetimibe or PCSK9 inhibitors), the findings were similar. In a meta-regression, a 10% decrease in LDL-C or non-HDL-C levels, was associated, respectively, with 0.92 mm3 and 1.05 mm3 regressions in TAV. Conclusion Our data suggest the addition of ezetimibe or PCSK9 inhibitors to statin therapy results in significantly increased regression of TAV. When the LDL-C and non-HDL-C levels reached were lower, the observed effect was also greater. Forest Plot by Drugs Group Funding Acknowledgement Type of funding source: None

P5015Efficacy of lipid lowering therapy beyond statins to prevent cardiovascular events: A meta-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Dykun ◽  
R Mincu ◽  
M Totzeck ◽  
T Rassaf ◽  
A A Mahabadi
Keyword(s):  
Myocardial Infarction ◽  
Relative Risk ◽  
Statin Therapy ◽  
Risk Reduction ◽  
Cardiovascular Events ◽  
Ldl Cholesterol ◽  
Meta Analysis ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy

Abstract Background Lipid lowering therapy is a key cornerstone in secondary prevention of patients with coronary artery disease. However, only a minority of patients with statin therapy reach LDL thresholds as suggested by the ESC. Ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors allow for reduction in LDL-cholesterol in addition to statin therapy. Purpose To perform a meta-analysis of existing trials, evaluating how lipid lowering therapy beyond statins impacts cardiovascular outcome. Methods We performed a systematic search using the Pubmed, Cochrane, SCOPUS, and Web of Science databases for studies, evaluating the impact of an intensified lipid lowering therapy via ezetimibe or PCSK-9 inhibitor in addition to statin therapy compared to statin therapy alone. Manuscript and congress presentations, published until 1st of November 2018, were included. We made our search specific and sensitive using Medical Subject Headings terms and free text and considered studies published in English language. Search terms used were “ezetimibe”, “evolocumab”, “alirocumab”, or “bococizumab” and “cardiovascular events”. Results A total of 100,610 patients from 9 randomized controlled trials (IMPROVE-IT, FOURIER, ODYSSEY Outcomes, SIPRE I, SPIRE II, ODYSSEY LONG TERM, OSLER-1 and OSLER-2, HIJ-PROPER) were included. Treatment with ezetimibe or a PCSK-9 inhibitor was associated with a 18% risk reduction in cardiovascular events (OR [95% CI]: 0.82 [0.75–0.89]). Effect sizes were similar for myocardial infarction (0.84 [0.76–0.92]) and even more pronounced for ischemic stroke (0.77 [0.67–0.83]). In contrast, all-cause mortality was not improved by the intensified lipid lowering therapy (0.94 [0.85–1.05]). No relevant heterogeneity and inconsistency between groups was present in all analyses (detailed data not shown). Comparing efficacy of LDL-reduction and relative risk redaction of cardiovascular events, a linear relationship was observed (figure). Figure 1. Correlation of reduction of LDL-cholesterol at one year with relative risk reduction (95% confidence interval) of cardiovascular events in included trials. Conclusion Intensified LDL-lowering therapy with ezetimibe or PCSK-9 inhibitors, in addition to statins, reduces the risk of myocardial infarction and stroke, however, does not impact overall mortality. There is a linear relationship between LDL reduction and cardiovascular risk reduction, confirming the beneficial effects of LDL lowering therapy beyond statins in secondary prevention.

scholarly journals Association Between Dietary Intake and Lipid-lowering Therapy: Prospective Analysis Using a Quantile Regression Approach (OR22-03-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Adelle Gadowski ◽  
Natalie Nanayakkara ◽  
Stephane Heritier ◽  
Dianna Magliano ◽  
Jonathan Shaw ◽  
...  
Keyword(s):  
Dietary Intake ◽  
Quantile Regression ◽  
Daily Intake ◽  
Lipid Lowering ◽  
Current Evidence ◽  
Lipid Lowering Therapy ◽  
Food Groups ◽  
Dietary Behaviours ◽  
Lowering Therapy

Abstract Objectives Lipid-lowering therapy (LLT) is ideally accompanied by dietary guidance for cardiovascular risk reduction, however current evidence suggests sub optimal dietary behaviours in those on pharmacological interventions. This study examines associations between daily intake of major food groups (vegetable, fruit, cereal, protein and dairy) and LLT use in Australian adults. Methods Data were analysed from 5895 participants of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) aged ≥ 25 years. Medical history and dietary intake was obtained at baseline (1999–00) and follow up (2004–05). LLT use was categorised as: LLT users, commenced LLT, ceased LLT, and non-users. The association between dietary intake and LLT use was examined using quantile regression, at the 25th, 50th and 75th quantile of dietary intake. Analysis was adjusted for known risk factors. Results A total of 446 participants remained on LLT from baseline to follow up; 565 participants commenced LLT; 71 participants ceased LLT and 4813 were non-users. Less than 1% of the cohort met recommended intakes of all food groups at baseline and follow up, with no difference by LLT status. Median daily dietary intake at follow up among LLT users was 2.2 serves of vegetables, 1.4 serves of fruit, 2.8 serves of cereal, 2.0 serves of protein and 1.4 serves of dairy. Dietary intake was similar across all LLT groups. LLT use was not significantly associated with dietary intake at the 25th, 50th and 75th quantile. Conclusions Adjusted quantile regression analysis showed no differences in median daily intake of key food groups in LLT users, compared to non-users. The dietary behaviours observed suggest that all adults, regardless of their medication regimen, need additional education on improving their dietary intake. These findings emphasise the importance of addressing adherence to dietary guidelines, for people with chronic disease, with special focus on people requiring LLT. Funding Sources Nil Supporting Tables, Images and/or Graphs

5130Association between degree of LDL-cholesterol decrease after a myocardial infarction and mortality - a nationwide cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Schubert ◽  
B Lindahl ◽  
H Melhus ◽  
H Renlund ◽  
M Leosdottir ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Lower Risk ◽  
Ldl Cholesterol ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Index Event ◽  
Risk Of Death ◽  
Lowering Therapy ◽  
Statin Use

Abstract Background In clinical trials, patients with myocardial infarction (MI) and elevated LDL-cholesterol (LDL-C) benefit the most from lipid lowering therapy, and more intensive LDL-C lowering therapy is associated with better prognosis. Purpose To investigate the association between degree of LDL-C lowering and prognosis in MI patients from a large real-world setting. Methods Patients admitted with an MI between 2006 and 2016 and registered in the Swedish MI-registry (SWEDEHEART) were followed until 2018. The difference in LDL-C between the MI hospitalization and a 6–10 week follow-up was measured. In multivariable Cox regression analysis adjusting for clinical risk factors (eg. age, diabetes, prior cardiovascular disease), the association between LDL-C change, mortality and recurrent MI was assessed using restricted cubic splines. Further, the patients were stratified according to quartile decrease in LDL-C from MI hospitalization to the follow-up. Results A total of 44,148 patients (median age: 64) had an LDL-C measured during the MI hospitalization and at follow-up. Of these, 9,905 (22.4%) had ongoing statin treatment prior to admission. The median LDL-C at the MI hospitalization was 2.96 (interquartile range 2.23, 3.74) mmol/L and the median decrease in LDL-C was 1.17 (0.37, 1.86) mmol/L. During a median follow-up of 3.9 years, 3,342 patients died and 3,210 had an MI. Patients with the highest quartile of LDL-C decrease (1.86 mmol/L) from index event to follow-up, had a lower risk of mortality, hazard ratio (HR) 0.59 (95% confidence interval [CI] 0.44–0.80) compared to those with the lowest quartile of LDL-C decrease (0.37 mmol/L) (figure). For MI, the corresponding HR was 0.83 (95% CI 0.68–1.02). Ongoing statin-use prior to admission did not alter the effect of LDL-C decrease and outcome in the analysis. Conclusions In this large nationwide cohort of MI patients, a gradually lower risk of death was observed in patients with larger decrease in LDL-C from index event to follow-up, regardless of statin use prior to admission. The same trend was observed for recurrent MI, although not reaching statistical significance. This confirms previous findings that efforts should be made to lower LDL-C after MI.

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