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

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

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

Methods: 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).

Results: 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 less than 70 mg/dL.

Conclusions: 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 less than 55 mg/dL, would be beneficial for atherosclerosis treatment.