Targeting Vulnerable Plaques in Coronary Artery Disease: Detecting Risk, Preventing Events

To summarize the key features of vulnerable plaques identified by intracoronary and non-invasive imaging and explore how anti-atherosclerotic therapies contribute to plaque regression and stabilization.

Compared with high-dose statin therapy, intensive lipid-lowering with proprotein convertase subtilisin/kexin type 9 inhibitors achieves lower low-density lipoprotein cholesterol (LDL-C) levels and results in greater plaque regression and fibrous cap thickening. Recent data suggest that preventive intervention for functionally non-significant but high-risk plaques may reduce clinical events, and this strategy is now being further evaluated in randomized controlled trials. Detecting and treating vulnerable plaques is essential for improving the prognosis of patients with coronary artery disease. The extent of plaque volume reduction and fibrous cap thickening appears closely associated with on-treatment LDL-C levels. Anti-inflammatory therapies may provide additional stabilizing effects. Preventive treatment of high-risk, non-obstructive lesions and the use of non-invasive imaging to identify vulnerable plaques and high-risk individuals are promising strategies warranting further research.