AIMS:

Near-infrared spectroscopy (NIRS)-detected lipid-rich plaques (LRPs) are associated with increased cardiovascular event risk. The aim of this study was to evaluate the effect of escalated novel statin-based hypolipidaemic therapy for plaque lipid content reduction.

METHODS AND RESULTS:

NIRS-IVUS investigation was performed in premature atherosclerosis patients having a 20-50% atherosclerotic plaque in the proximal or middle third of a coronary artery, followed by repeated investigation of the segment of interest after 15 months. LRPs were defined as lesions with maximum lipid-core burden index within 4 mm (maxLCBI4 mm) >250 in the chemogram. Patients were on high-intensity statin (atorvastatin 40 or 80 mg and rosuvastatin 20 or 40 mg) and optional ezetimibe treatment. Those not achieving low-density lipoprotein cholesterol (LDL-C) target of <1.8 mmol/l after a run-in period of 4-6 weeks, were assigned to receive inclisiran. Baseline LDL-C refers to the level at the time of optimal lipid-lowering treatment initiation. Data of 35 patients was analyzed. Mean baseline maxLCBI4 mm was 191.6. Overall, maxLCBI4 mm reduction by 43.8% (-84.0, 95%CI -132.5 to -35.4) was established (P=0.002). LRPs were detected in 13 study participants with mean maxLCBI4 mm value of 370.6. After 15 months, maxLCBI4 mm decreased by 41.0%  (-151.8, 95%CI -267.2 to -36.5)  in patients with LRPs (P=0.013) and by 51.0% (-43.8, 95%CI -81.0 to -6.7) among others (P=0.028). 20 patients received add-on inclisiran. Among all patients, mean baseline LDL-C was 2.4 mmol/l, reduced by 33.3% (-0.8, 95%CI -1.1 to -0.4) (P<0.001). After 15 months 71.4% of patients achieved LDL-C level target <1.8 mmol/l.

CONCLUSION:

High-dose statin-based therapy intensified with proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition demonstrated effective atherosclerotic lesion stabilization through lipid content reduction when assessed by NIRS.