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Effects of high- versus low-intensity lipid-lowering treatment in patients undergoing serial coronary computed tomography angiography: results of the multi-center LOCATE study

Weichsel L, André F, Renker M, Breitbart P, Overhoff D, Beer M, Giesen A, Vattay B, Buß SJ, Marwan M, Schlett CL, Giannopoulos AA, Kelle S, Frey N, Korosoglou G, Giusca S, Schütz M, Weberling LD, Schmitt R, Schönberg SO, Kuru M, Klömpken S, Szilveszter B, Maurovitch-Horvat P, Görich J, Emami M, Kaufmann PA, Doeblin P, Solowjowa N, Weiß KJ, Baumann S, Stach K (2024)

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Publication Language: English

Publication Type: Journal article

Publication year: 2024

Journal

DOI: 10.1007/s00392-024-02502-6

Abstract

Aim: To evaluate the effects of lipid-lowering medications of different intensities on total, calcified, and non-calcified plaque volumes in patients undergoing serial cardiac computed tomography angiography (CCTA). Methods: Individuals with chronic coronary syndromes from 11 centers were included in a retrospective registry. Total, calcified, and non-calcified plaque volumes were quantified and the relative difference in plaque volumes between baseline and follow-up CCTA was calculated. The intensity of lipid-lowering treatment was designated as low, moderate, or high, based on current recommendations. Results: Of 216 patients (mean age 63.1 ± 9.7 years), undergoing serial CCTA (median timespan = 824.5 [IQR = 463.0–1323.0] days), 89 (41.2%) received no or low-intensity lipid-lowering medications, and 80 (37.0%) and 47 (21.8%) moderate- and high-intensity lipid-lowering agents, respectively. Progression of total and non-calcified plaque was attenuated in patients on moderate-/high- versus those on no/low-intensity treatment and arrested in patients treated with high-intensity statins or PCSK9 inhibitors (p < 0.001). Halted increase of non-calcified plaque was associated with LDL-cholesterol reduction (p < 0.001), whereas calcified plaque mass and Agatston score increased irrespective of the lipid-lowering treatment (p = NS). The intensity of lipid-lowering therapy robustly predicted attenuation of non-calcified plaque progression as a function of the time duration between the two CCTA scans, and this was independent of age and cardiovascular risk factors (HR = 3.83, 95% CI = 1.81–8.05, p < 0.001). Conclusion: The LOCATE multi-center observational study shows that progression of non-calcified plaques, which have been previously described as precursors of acute coronary syndromes, can be attenuated with moderate-intensity, and arrested with high-intensity lipid-lowering therapy. German clinical trials register: DRKS00031954. Graphical abstract: High-intensity lipid-lowering agents, including potent statins and PCSK9 inhibitors induce intense LDL-cholesterol reduction and arrest of non-calcified plaque. (Figure presented.)

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APA:

Weichsel, L., André, F., Renker, M., Breitbart, P., Overhoff, D., Beer, M.,... Stach, K. (2024). Effects of high- versus low-intensity lipid-lowering treatment in patients undergoing serial coronary computed tomography angiography: results of the multi-center LOCATE study. Clinical Research in Cardiology. https://doi.org/10.1007/s00392-024-02502-6

MLA:

Weichsel, Loris, et al. "Effects of high- versus low-intensity lipid-lowering treatment in patients undergoing serial coronary computed tomography angiography: results of the multi-center LOCATE study." Clinical Research in Cardiology (2024).

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