The Effect of Lipid-Lowering Therapy on Coronary Artery Plaque in East Asia Population

Lipid-lowering therapy (LLT) is important to control atherosclerosis and prevent atherosclerotic cardiovascular disease (ASCVD) events.

This study aimed to summarize the effects of LLT on coronary atherosclerotic plaque stability and progression in East Asian individuals.

A systematic literature search was performed from respective inception dates to November 21, 2023. Studies carried out on East Asian participants who received LLT were included. Meta-analysis and meta-regression analysis were used to investigate the effects of LLT on plaque regression indicators and plaque stabilization indicators (PROSPERO registration number CRD42024504184).

Forty-eight studies with a total of 4,147 patients were included in the final analysis. In East Asian patients, low-density lipoprotein cholesterol (LDL-C) levels ≤130 mg/dL resulted in a pooled percent atheroma volume decrease of -1.09% (95% CI: -1.38% to -0.79%; I² = 91%), and the lowest levels of LDL-C (≤55 mg/dL) were associated with the greatest decrease (-1.56%, 95% CI: -2.20% to -0.92%; I² = 0%) of percent atheroma volume when compared with levels in the range of 55 to 70, 70 to 100, and 100 to 130 mg/dL. LLT resulted in a pooled fibrous cap thickness gain of 66.90 μm (95% CI: 50.06-83.75 μm) at the end of the follow-up. There was a trend that decreasing follow-up LDL-C levels were associated with larger increases of fibrous cap thickness, especially when LCL-C was <70 mg/dL.

LLT is beneficial for East Asian patients with established ASCVD or with higher risks of ASCVD. Intensive LLT with a lower target LDL-C, especially to <55 mg/dL, would be beneficial for atherosclerosis treatment.