Low-density lipoprotein cholesterol reduction is associated with computed tomography angiography signs of regression and stabilization of coronary plaque: from the TARGET trial

Background and purpose: The effectiveness of low-density lipoprotein cholesterol (LDL-C) lowering therapy in patients with higher baseline LDL-C levels has been extensively studied in Western populations. However, it remains uncertain whether the standard low-to-moderate lipid-lowering therapy practiced in Chinese individuals can lead to coronary plaque regression. Our objective is to explore the connections between plaque regression/stabilization, baseline LDL-C levels, and the extent of LDL-C reduction. Methods: This study constitutes a post hoc analysis derived from the TARGET trial, which initially recruited patients diagnosed with stable coronary artery disease (CAD) exhibiting an intermediate stenosis range of 30% to 90% as detected through coronary computed tomographic angiography (CCTA). Eligible participants for this analysis had undergone both baseline CCTA and a minimum 1-year follow-up. Patients were categorized into four groups based on their LDL-C levels and the degree of LDL-C reduction during the follow-up period. The assessment of coronary plaque regression within each group was conducted through the analysis of CCTA images, examining parameters such as total plaque (TP), percent atheroma volume (PAV), non-calcified plaque (NCP), low-attenuation plaque (LAP), and calcified plaque (CP). Results: Among the participants analyzed, totaling 287 individuals with an average age of 59.7 ± 7.1 years, comprising 69.7% men, the median duration between the initial and subsequent scans stood at 21 months (Q1–Q3, 15–29 months). Among these, 76 patients (26.5%) had been receiving statin therapy consistently before the baseline scan (defined as continued statin treatment), while 179 patients (62.3%) had commenced statin therapy after the baseline scan but before the follow-up scan (classified as new statin therapy). Notably, plaque regression was observed in 79 patients (28%), notably more frequent in those with higher baseline LDL-C levels and individuals who achieved a >25% reduction in LDL-C ( P < 0.001). The median annual progression of TP was 1.9 (interquartile range [IQR] = −3.6 to 11.8), while for NCP, it was 1.5 (IQR = −4.6 to 11.0). In a multivariate logistic regression analysis, plaque regression demonstrated independent associations with LDL-C reduction exceeding 25% (odds ratio [OR] = 2.103, 95% confidence interval [95% CI] = 1.408–3.836) and baseline LDL-C levels (OR = 1.024, 95% CI = 1.004–1.044). Conclusions: Modest LDL-C reduction was associated with computed tomography angiography (CTA) evidence of coronary plaque regression and stabilization. The plaque regression is particularly marked in patients with a high baseline LDL-C level and LDL-C reduction of >25%.