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2016;248:117–22. N Engl J Med. When the LDL-C and non-HDL-C levels reached were lower, the observed effect on atherosclerosis regression was also greater. The analysis was considered robust when the results obtained were similar. The non-statin cholesterol-lowering medications are also effective at lowering LDL but to a lesser extent. Alirocumab and cardiovascular OutcomesafterAcuteCoronarySyndrome. Another point of this study is that it evaluates through a meta-regression analysis the effect of lipid levels reduction generated by dual lipid-lowering therapy on the regression of atherosclerosis. The recommendations to consider non-statin therapies to all patients with clinical ASCVD are based on evidence from FOURIER and IMPROVE-IT trials. Hibi K, Sonoda S, Kawasaki M, Otsuji Y, Murohara T, Ishii H, et al. Role of non-statin lipid-lowering therapy in coronary atherosclerosis regression: a meta-analysis and meta-regression. 2016;16:87. Biondi-Zoccai G, Mastrangeli S, Romagnoli E, Peruzzi M, Frati G, Roever L, et al. In combination, the … Ako J, Hibi K, Tsujita K, Hiro T, Morino Y, Kozuma K, et al. Impact of dual lipid-lowering strategy with Ezetimibe and atorvastatin on coronary plaque regression in patients with percutaneous coronary intervention: the multicenter randomized controlled PRECISE-IVUS trial. Article Masson W, Siniawski D, Lobo M, Molinero G, Giorgi M, Huerín M. Association between LDL-C, non HDL-C, and Apolipoprotein B levels with coronary plaque regression. What we have learned from the recent meta-analyses on diagnostic methods for atherosclerotic plaque regression. Effect of statin therapy on the progression of common carotid artery intima-media thickness: an updated systematic review and meta-analysis of randomized controlled trials. BMJ. Gerardo Masson contributed with manuscript revision. However, they did not evaluate other non-statin drugs such as PCSK9 inhibitors. The writing committee recommended monitoring lipids at 4-12 weeks after modification to LDL-lowering therapy, including the addition of a non-statin therapy. Consideration of non-statin therapies to provide adequate percent LDL lowering was based on evidence from two trials: 1) FOURIER, which included patients with clinical ASCVD with or without DM; and SPIRE-2, which included high-risk primary prevention patients and patients with familial hypercholesterolemia. Beyond cholesterol metabolism: the pleiotropic effects of proprotein convertase subtilisin/kexin type 9 (PCSK9). 2015;66:495–507. Medicina (B Aires). N Engl J Med. J AtherosclerThromb. Gragnano F, Calabrò P. Role of dual lipid-lowering therapy in coronary atherosclerosis regression: evidence from recent studies. Sahebkar A, Di Giosia P, Stamerra CA, Grassi D, Pedone C, Ferretti G, et al. Walter Masson and Daniel Siniawski drafted the manuscript of the present paper. Several studies have investigated the association between non-statin lipid-lowering therapy and regression of atherosclerosis. Furthermore, when we analyzed the non-HDL-C, meta-regression showed similar results (P = 0.0057). Google Scholar. Grundy SM, Stone NJ, Guideline Writing committee for the 2018 cholesterol Guidelines. 2015;105:11–9. Article Lipid profile associated with coronary plaque regression in patients with acute coronary syndrome: subanalysis of PRECISE-IVUS trial. Through this analysis, the results of the meta-analysis were replicated excluding in each step one of the studies included in the review. Effect of combination therapy of ezetimibe and rosuvastatin on regression of coronary atherosclerosis in patients with coronary artery disease. Br J Clin Pharmacol. Cardiovasc Revasc Med. In the same way, several studies have demonstrated that statin therapy promotes coronary atheroma stabilization and regression in patients with acute coronary events or stable coronary disease [7,8,9,10,11]. 2010;376:1670–81. CAS 2020;28(3):744–55. However, the studies were mostly small and their results were not always robust [14,15,16,17,18,19,20,21]. 2013;226:178–85. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Cochrane Database Syst Rev. 2018;82:757–66. Earn CME/MOC Credit: Lowering Lipid Levels: Reducing Risk and Improving Outcomes, ACC and Medscape Collaboration: Cardiovascular Risk Reduction Center of Excellence, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism. Simvastatinwithorwithoutezetimibe in familialhypercholesterolemia. The level of statistical significance was set at a two-tailed alpha of 0.05. Similarly, in the IMPROVE-IT and the FOURIER studies the extent of benefit afforded by the statin-ezetimibe or statin-evolocumab combination respectively, was consistent with that seen in the CTT meta-analysis, with a similar reduction in cardiovascular events according to the degree of LDL-C lowering [12, 29]. Sensitivity analysis. 2019;26:199–207. Low-density lipoprotein cholesterol (LDL-C): how low? 2006;295:1556–65. D’Ascenzo F, Agostoni P, Abbate A, Castagno D, Lipinski MJ, Vetrovec GW, et al.