Intensive vs More Intensive Lipid-Lowering Therapy and Plaque Regression in Statin-Naive Patients: Prespecified Analyses From the FLOWPROMOTE Randomized Clinical Trial
Authors' conclusion
This secondary analysis of the FLOWPROMOTE randomized clinical trial demonstrated that in statin-naive patients with CAD, more intensive lipid-lowering therapy was associated with significantly greater regression of total and noncalcified coronary plaque burden compared with intensive therapy. The extent of plaque regression was related to achieved LDL-C levels, supporting the potential for partial reversal of coronary atherosclerosis with intensive lipid reduction.
Study context
- Population
- Statin-naive patients with newly diagnosed stable coronary artery disease (CAD), defined by a coronary computed tomography angiography (CTA) stenosis greater than 50% and fractional flow reserve CT less than or equal to 0.80included in this analysis
- Participants
- 104 patients
- Comparison
- More intensive vs intensive
- More intensiven = 52
- Intensiven = 52
Methodological detailssecondary analysis, prespecified secondary imaging end points
- Secondary analysis
- Prespecified secondary imaging end points
Primary result
As reported in the abstract
Intensive
from 119.7 to 69.5 mg/dL
change −38%
More intensive
from 127.4 to 42.5 mg/dL
change −65%
Secondary outcomes
mm³
| Outcome | More intensive | Intensive | Between-group difference (mm³) (95% CI) | P value | |
|---|---|---|---|---|---|
| Change in total plaque volume (TPV) · 18 monthsGreater regression with more intensive therapy | −69.8 (−21.1%) | −39.0 (−13.6%) | −30.9 (−57.2 to −4.5) | P = 0.02 | |
| Change in noncalcified plaque volume (NCPV) · 18 monthsGreater regression with more intensive therapy | −82.3 (−28.2%) | −53.5 (−20.0%) | −28.9 (−53.2 to −4.6) | P = 0.02 | |
| −100−50050Difference, mm³ (linear scale) |
Regression of TPV (patients)
Regression of NCPV (patients)
- Regression of total plaque volume (TPV) (patients): P = .05
- Regression of TPV (patients): text also prints 76% for intensive therapy
- Regression of noncalcified plaque volume (NCPV) (patients): P =.001
Change in calcified plaque volume (CPV)
- CPV increased similarly in both groups
Achieved low-density lipoprotein cholesterol (LDL-C) and plaque regression
- Lower achieved LDL-C levels were linearly associated with greater regression of TPV and NCPV
Original publication
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