Background: Lipid-lowering therapy (LLT) is important to control atherosclerosis and prevent atherosclerotic cardiovascular disease (ASCVD) events.
Objectives: This study aimed to summarize the effects of LLT on coronary atherosclerotic plaque (CAP) stability and progression in East Asians.
Methods: A systematic literature search was performed from respective inception dates to November 21, 2023. Studies carried out on East Asian participants who received LLT were included. Meta-analysis and meta-regression analysis were used to investigate the effects of LLT on plaque regression indicators and plaque stabilization indicators (PROSPERO registration number CRD42024504184).
Results: Forty-eight studies with a total of 4,147 patients were included in the final analysis. In East Asian patients, low-density lipoprotein cholesterol (LDL‑C) levels ≤ 130 mg/dL resulted in a pooled percent atheroma volume (PAV) decrease of ‑1.09% (95% CI: ‑1.38%, ‑0.79%, I2 = 91%), and the lowest levels of LDL‑C (≤55 mg/dL) were associated with the greatest decrease (‑1.56%, 95% CI: ‑2.20%, ‑0.92%, I2 = 0%) of PAV when compared with levels in the range of 55‑70, 70‑100, and 100‑130 mg/dL. LLT resulted in a pooled fibrous cap thickness (FCT) gain of 66.90μm (95% CI: 50.06μm, 83.75μm) at the end of the follow-up. There was a trend that decreasing follow-up LDL‑C levels were associated with larger increases of FCT, especially when LCL-C was less than 70 mg/dL.
Conclusions: LLT is beneficial for East Asian patients with established ASCVD or with higher risks of ASCVD. Intensive LLT with a lower target LDL‑C, especially to less than 55 mg/dL, would be beneficial for atherosclerosis treatment.
Editors
JACC: Asia Editor-in-Chief
Jian’an Wang, MD, PhD, FACC
CME Editor
Kenneth A. Ellenbogen, MD
Author
Valerian Fernandes, MBBS, FACC
Important Dates
Date of Release: August 5, 2025
Term of Approval/Date of CME/MOC Expiration: August 4, 2026