Usefulness of lipid-lowering therapy in stabilizing vulnerable atherosclerotic plaque: Focus on intraplaque neovascularization

Background Intraplaque neovascularization (IPN) is related to the progression of atherosclerotic plaque. The impact of lipid-lowering therapy (LLT) on IPN regression is unclear. We aimed to investigate the efficacy of LLT to regress IPN. Methods Between April 2022 and July 2024, 56 patients who had percutaneous coronary intervention (PCI) for angina or acute coronary syndrome and had not used LLT for at least 6 months were included. Contrast-enhanced ultrasound (CEUS) of the carotid artery was performed to evaluate IPN and intima–media thickness (IMT) within 7 days post-PCI. They received a combination of rosuvastatin 10 mg and ezetimibe 10 mg starting after PCI and continued for 1 year. Lipid profile changes and contrast enhancement were evaluated at baseline and 1 year later. The primary outcome was IPN regression, defined as the downgrade changes in the enhancement of contrast in atherosclerotic plaque at follow up. Results The mean follow up was 12.6 ± 0.9 months. The IPN regression rate was 41%. Patients achieving IPN regression initially had a higher low-density lipoprotein-cholesterol (LDL-C) level and a greater percentage reduction in LDL-C. Whereas lipid profiles change significantly, no notable alterations were observed in IMT, plaque thickness, or plaque density. However, a 59% reduction in LDL-C was identified as the optimal cutoff level for IPN regression (OR 0.86, 95% CI 0.75–0.96). Conclusion LLT, such as rosuvastatin 10 mg with ezetimibe 10 mg, may effectively inhibit IPN by reducing LDL-C levels, providing a promising treatment option.