A wide range of pharmaceutical agents lower LDL-cholesterol and may also lead to reversal of atherosclerosis and coronary artery disease (CAD) but more data is needed and their ability to reduce CAD burden is controversial.
STUDY
Objective To evaluate the association between coronary plaque regression assessed by intravascular ultrasound (IVUS) during invasive coronary angiography and and an outcome called major adverse cardiovascular events (MACE).
Data Sources A comprehensive, systematic search of publications in PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science was performed.
Study Selection Clinical prospective studies of lipid lowering therapies like statins (Lipitor, Crestor etc) and PCSK9 inhibitors (Repatha and Praluent) reporting change in percent atheroma volume (PAV) assessed by IVUS and describing MACE components were selected.
Results The meta-analysis included 23 studies published between July 2001 and July 2022, including 7407 patients and trial durations ranging from 11 to 104 weeks. Mean patient age ranged from 56 to 70 years.. Change in PAV across 46 study arms ranged from −5.6% to +3.1% (a negative number indicates plaque reversal).
In unadjusted analysis, a 1% decrease in mean PAV was associated with 17% reduced odds of MACEs.
Further adjustment for cardiovascular risk factors showed a 19% reduced risk per 1% decrease in PAV.
A 1% reduction of PAV change between intervention and comparator arms within studies was also associated with a significant 25% reduction in MACEs.
Conclusions and Relevance In this meta-analysis, reversal of atherosclerotic plaque in CAD patients by just 1% was associated with a 25% reduction in the odds of MACEs.
The senior author, Dr. G. B. John Mancini, a professor of Medicine at the University of British Columbia and a mentor of mine in medical school in Ann Arbor said that “This study is the most up-to-date systematic review and meta-analysis that confirms an association between plaque regression and reduction in major adverse cardiovascular events”.
This research is the first time researchers have been able to directly demonstrate that reducing plaque is directly associated with a lower risk of adverse cardiovascular events.
“Inducing a reduction of plaque volume by aggressive and sustained lipid-lowering should be of value in improving health, but the direct relationship, as shown in the current analysis, has been difficult to show through any individual study,” said Mancini.
“We now provide evidence for the beneficial association between plaque regression and reduction of major adverse cardiovascular events through sophisticated meta-regression analysis of all the available studies,” said Mancini.
IMPLICATIONS
This large systematic review adds lipid lowering therapies like statins to the prior lifestyle and diet trials like the Lifestyle Heart Trial by Dean Ornish, MD and others as proven approaches to reverse CAD. Even small improvements have BIG benefits.
