At the KAHN CENTER we utilize quantitative coronary CT angiography (CCTA) to identify, measure, and plan reversal of coronary plaque. But can plaque really be reversed?

And, does more intensive lipid-lowering therapy lead to greater regression of coronary atherosclerotic plaque across the entire coronary tree compared with intensive therapy in statin-naive patients with stable coronary artery disease?

A new study provides encouraging results that say yes!

STUDY

In this randomized clinical trial (FLOWPROMOTE) of 104 statin-naive patients with stable coronary artery disease assessed by cCCTA, more intensive lipid-lowering therapy (rosuvastatin 40 mg + ezetimibe 10 mg) achieved lower low-density lipoprotein cholesterol (LDL-C) levels and resulted in significantly greater regression of total and noncalcified coronary plaque volume compared with intensive therapy (atorvastatin 40 mg) over 18 months of treatment. Lower achieved LDL-C levels were linearly associated with greater plaque regression.

A total of 104 patients (age 64 years; 82 male [79%]) were included with 52 patients in the intensive group and 52 patients in the more intensive group.

RESULTS

LDL-C levels decreased from 120 to 70 mg/dL (−38%) with intensive therapy and from 127 to 42 mg/dL (−65%) with more intensive therapy.

At 18 months, both total plaque volume (TPV) and non-calcified plaque volume (NCPV) decreased in both groups, with significantly greater regression in the more intensive–therapy group. TPV was reduced by −69.8 mm3 (−21.1%) with more intensive therapy vs −39.0 mm3 (−13.6%) with intensive therapy (between-group difference, −30.9 mm3; 95% CI, −57.2 to −4.5 mm3; P = .02), and NCPV was reduced by −82.3 mm3 (−28.2%) vs −53.5 mm3 (−20.0%), respectively (between-group difference, −28.9 mm3; 95% CI, −53.2 to −4.6 mm3; P = .02).

Calcified plaque volume (CPV) increased similarly in both groups.

Regression of TPV occurred in 90% of patients receiving more intensive therapy compared with 76% receiving intensive therapy and regression of NCPV was observed in 98% vs 77%.

Lower achieved LDL-C levels were linearly associated with greater regression of TPV and NCPV.

CONCLUSIONS

This secondary analysis of the FLOWPROMOTE randomized clinical trial demonstrated that in statin-naive patients with CAD, more intensive lipid-lowering therapy was associated with significantly greater regression of total and noncalcified coronary plaque burden compared with intensive therapy.

The extent of plaque regression was related to achieved LDL-C levels, supporting the potential for partial reversal of coronary atherosclerosis with intensive lipid reduction

At the KAHN CENTER, we will educate patients on the goals of plaque reversal (non calcified plaque) and the need for intensive therapy reaching low LDL-C targets. We use lifestyle, supplements, and Rx medications as needed.

These are exciting times!