The effects of lipid-lowering therapy on coronary plaque regression: a systematic review and meta-analysis

To assess the influence of lipid-lowering therapy on coronary plaque volume, and to identify the LDL and HDL targets for plaque regression to provide a comprehensive overview. The databases searched (from inception to 15 July 2020) to identify prospective studies investigating the impact of lipid-lowering therapy on coronary plaque volume and including quantitative measurement of plaque volume by intravascular ultrasound after treatment. Thirty-one studies that included 4997 patients were selected in the final analysis. Patients had significantly lower TAV (SMD: 0.123 mm(3); 95% CI 0.059, 0.187; P=0.000) and PAV (SMD: 0.123%; 95% CI 0.035, 0.212; P=0.006) at follow-up. According to the subgroup analyses, TAV was significantly reduced in the LDL<80 mg/dL and HDL>45 mg/dL group (SMD: 0.163 mm(3); 95% CI 0.092, 0.234; P=0.000), and PAV was significantly reduced in the LDL<90 mg/dL and HDL>45 mg/dL group (SMD: 0.186%; 95% CI 0.081, 0.291; P=0.001).Thirty-one studies that included 4997 patients were selected in the final analysis. Patients had significantly lower TAV (SMD: 0.123 mm(3); 95% CI 0.059, 0.187; P=0.000) and PAV (SMD: 0.123%; 95% CI 0.035, 0.212; P=0.006) at follow-up. According to the subgroup analyses, TAV was significantly reduced in the LDL<80 mg/dL and HDL>45 mg/dL group (SMD: 0.163 mm(3); 95% CI 0.092, 0.234; P=0.000), and PAV was significantly reduced in the LDL<90 mg/dL and HDL>45 mg/dL group (SMD: 0.186%; 95% CI 0.081, 0.291; P=0.001). Our meta-analysis suggests that not only should LDL be reduced to a target level of<80 mg/dL, but HDL should be increased to a target level of>45 mg/dL to regress coronary plaques.Trial Registration PROSPERO identifier: CRD42019146170.