Effect of different lipid-lowering therapies on fibrous cap thickness in CAD patients: a meta-analysis

Abstract Background and aims: Previous meta-analysis just assessed the effect of statin monotherapy rather than combination therapy on fibrous cap thickness (FCT). The objective of this meta-analysis was to evaluate the effect of different lipid-lowering therapies on FCT of coronary artery disease (CAD) patients assessed by optical coherence tomography (OCT).Methods: Data sources were selected from PubMed and Embase, including clinical trials assessing the relationship between lipid-lowering therapies and FCT on OCT, from inception to March 1st, 2022. The main subgroup analysis is based on different lipid-lowering therapies. Weighted mean difference (WMD) was evaluated by random effects model. Results: Seventeen OCT studies were included. A total of 1027 patients were enrolled in this meta-analysis. The overall random effect mean FCT change from baseline to follow-up was 53.81μm (95% CI: 44.07-63.55, I²=85%, p<0.00001). The random effect FCT mean change of between low & moderate statin therapy and high intensity statin therapy was 57.03μm vs. 91.50μm, in statin combination therapy and statin monotherapy was 46.89μm vs. 27.18μm. The p value of meta regression of diabetic mellitus (DM) was 0.004, and adjust R2 was 28.18%, which meant DM could explained 28.18% of heterogeneity in this meta-analysis. No evidence proved publication bias of the published studies. Conclusions: Lipid-lowering therapy can effectively increase FCT. High intensity statin therapy and statin combination lipid-lowering therapy can further improve FCT, stabilize plaques, and reduce the incidence of cardiovascular events.Trial registration: This meta-analysis has registered in PROSPERO, registration number: CRD42020181252.