Atherosclerosis is a health problem that many middle-aged and elderly people need to face as they age, which is the main physiological cause of cardiovascular disease. The occurrence of atherosclerosis is mainly due to the chronic inflammatory response of the vascular endothelium, which is gradually triggered by endothelial dysfunction, which is closely related to the influence of ongoing risk factors, such as uncontrolled hypertension, hyperglycemia and elevated blood lipids.
If the risk factors for atherosclerosis are left unchecked, it can lead to the progression of plaques, which can become larger and more unstable, leading to cardiovascular events. The development of plaque is also improved through interventions, and the general consensus is that lifestyle interventions such as healthy diet and exercise, as well as treatment with lipid-lowering drugs, can delay the progression of plaque or even trigger plaque regression.
Over the past three decades, lipid-lowering drugs have made great strides in reducing cardiovascular events, and there have been great advances in coronary artery imaging technology, which has made it possible to evaluate whether lipid-lowering drugs can achieve the effect of plaque regression.
How to take lipid-lowering drugs to improve or even continue to regress atherosclerotic plaque? Which lipid-lowering drugs can achieve such an effect? This is a question that many friends are concerned about, and a new meta-study recently published in the American Journal of Preventive Cardiology has evaluated and analyzed this problem. Today, I will combine the research content of this article and talk to you about this topic.
The aim of the study, which aimed to assess the effects of different lipid-lowering drug treatments on plaque regression, analysed more than 2500 studies and included 51 studies involving 9113 adults, of whom a relatively low proportion was female, accounting for 22%. The analysis evaluated the specific effects of multiple drug combinations on the improvement of atherosclerosis.
The lipid-lowering drug treatments included in the study were divided into 6 groups -
- High-intensity statins
- High-intensity statin + ezetimibe
- Low-intensity statins
- Low-strength statin + ezetimibe
- Low-strength statin + eicosapentaenoic acid (EPA)
- PCSK9 inhibitors
The primary outcome identified in the study was the change in the atherosclerosis volume ratio, which became smaller, indicating that the process of atherosclerosis was controlled, and also helped to reduce the risk of cardiovascular disease, and the secondary outcome was mainly the total atherosclerosis volume, the reduction of this total volume is a direct indication of the resolution of arterial plaque, in addition, the investigators also evaluated the arterial lumen volume, fiber cap thickness, lipid core arc and other indicators, the arterial lumen volume increased, the arterial plate fiber cap thickness became thicker, and the lipid arc content became smaller, are all related indicators of the stabilization of arterial plaque and the improvement of atherosclerosis.
After comprehensive analysis and evaluation of relevant clinical data, the study mainly came to the following results:
1. In terms of the change of atherosclerosis volume ratio of the main outcome, lipid-lowering drug treatment reduced this volume ratio by 1.10% overall, and according to the effect of no drug grouping, the high-intensity statin group, low-intensity statin + ezetimibe group, low-dose statin + EPA group, and PCSK9 group achieved a reduction in the volume ratio of atherosclerotic plaques, while no significant reduction in the volume ratio was observed in the other two drug groups.
In terms of volume ratio reduction, low-dose statin + ezetimibe had the best improvement effect, with a 4.07% reduction in arteriosclerosis volume ratio, followed by low-dose statin + EPA group with a 3.52% reduction, and high-dose statin and PCSK9 group with a 1.01% and 1.39% reduction in volume ratio, respectively.
2. For the change of the total volume of atherosclerotic plaque, the total plaque volume decreased by 5.84 cubic millimeters on average with lipid-lowering drug treatment, and the subgroup analysis of different drug groups found that the high-intensity statin group was the main driving force for the regression of arterial plaque, and the arterial plaque reduction volume in the high-intensity statin treatment group reached 7.60 cubic millimeters, and no significant reduction in the total volume of arterial plaque was observed in the other subgroups.
Comparing the relationship between the reduction of LDL cholesterol and the reduction of arteriosclerotic plaque volume in each treatment group, the researchers found that whether LDL cholesterol was lower than 1.8 mmol/L or higher than this value, even subgroups showed a significant reduction in arterial plaque volume, and the reduction was slightly higher in the lower than 1.8 group.
3. In terms of other arteriosclerosis indicators, studies have found that statin treatment can increase the thickness of the fibrous cap, and lipid-lowering drug treatment can increase the thickness of the fibrous cap by an average of 26.20μm, which is also similar to the results of previous related studies.
Through the above study, the investigators evaluated and analyzed the improvement effect of related drugs on atherosclerosis, and in this analysis, it was further affirmed that statins played an important role in the improvement of atherosclerosis, whether it was to reduce the total volume percentage of atherosclerosis, or to improve the thickness of the fibrous cap, stabilize plaque, etc., statins showed a good protective effect, which also suggested that for people with hyperlipidemia and the need to control the risk of atherosclerotic cardiovascular disease, Statins are within a safe tolerated dosage range, and should still be taken consistently.
Studies have found that high-dose statins can help to achieve plaque regression, but this way of medication is not suitable for our people, although high-dose statins reduce the volume of plaques to a certain extent, but also bring greater risk of adverse reactions, liver function impairment, muscle pain, blood sugar rise and other adverse reactions, are closely related to the intensity of statin medication.
Therefore, in terms of lipid-lowering drug treatment options, low-dose statins should be used in combination with other lipid-lowering drugs, which should be a better treatment that can also improve atherosclerosis and better ensure the safety of the drug. For example, the low-strength statin + ezetimibe, low-strength statin + high-purity one-component fish oil (EPA) formulation mentioned in the study are all good drug combinations.
In conclusion, reasonable lipid-lowering drug therapy is an effective way to control the risk of arteriosclerotic cardiovascular disease, especially if the drug regimen contains statins, which can help delay the progression of atherosclerosis, shrink plaque, shrink lipid core and increase fiber cap thickness, and stabilize plaque.
Bibliography:
Rivera FB, Cha SW, Varona MC, Fernandez Co EM, Magalong JV, Aparece JP, De Oliveira-Gomes D, Kaur G, Gulati M. Atherosclerotic coronary plaque regression from lipid-lowering therapies: A meta-analysis and meta-regression. Am J Prev Cardiol. 2024 Mar 11;18:100645.