Temporal changes and treatment-associated stabilization of aortic ruptured plaques assessed by non-obstructive general angioscopy
K Kojima, K Agune, N Kurito, S Tomimatsu, T Nishiwaki, T Nagao, Y Hotsubo, K Hori, Y Tanaka, K Fukumoto, Y Ebuchi, R Arai, S Migita, M Sudo, Y OkumuraAbstract
Background
Intensive lipid-lowering therapy reduces cardiovascular events by lowering low-density lipoprotein cholesterol (LDL-C) and stabilizing coronary vulnerable plaques in patients with coronary artery disease (CAD). Whether similar disease-modifying effects occur in ruptured plaques of the aorta remains unknown. Non-obstructive general angioscopy (NOGA) enables direct visualization of aortic plaque morphology and has been shown to predict cardiovascular, cerebrovascular, and peripheral vascular events. We investigated temporal changes in aortic ruptured plaques assessed by serial NOGA and their association with the intensity of lipid lowering.
Methods and Results
We retrospectively analyzed 65 patients with CAD who underwent serial NOGA examinations between April 2017 and October 2023. Ruptured plaques were defined as puff ruptures and puff-chandelier ruptures, and plaque frequency was calculated as the number of plaques divided by observed segments. The mean follow-up period was 296 ± 198 days.
LDL-C significantly decreased from 90.0 ± 36.1 mg/dL to 61.7 ± 19.6 mg/dL (p < 0.001). Overall, ruptured plaque proportion decreased from 19% to 12% (p = 0.013). Patients achieving LDL-C <55 mg/dL showed significant plaque reduction (p = 0.01), whereas those with LDL-C ≥55 mg/dL did not (p = 0.21). Similarly, ≥50% LDL-C reduction was associated with significant plaque stabilization (p = 0.02), while lesser reduction was not (p = 0.14). Plaque frequency decreased in both groups, with a numerically larger absolute reduction in patients treated with PCSK9 inhibitors (0.12→0.06 vs. 0.11→0.07).
Conclusion
Intensive lipid lowering, particularly achieving LDL-C <55 mg/dL or ≥50% reduction, is associated with stabilization of aortic ruptured plaques visualized by NOGA. These findings suggest that strict lipid management may exert disease-modifying effects on systemic atherosclerosis beyond the coronary arteries.Aortic Atheroma by Angioscopy