Atherosclerosis progression in subjects with very high cardiovascular risk in treatment with a high-intensity lipid-lowering regimen. An observational study

Background and Aims: Intima media thickness (IMTc) regression on carotid arteries has been associated with the reduction of cardiovascular disease. There are few data about the progression of atherosclerosis measured by 2D ultrasound after intensive lipid-lowering treatment. Our study aimed to describe the progression of IMTc and plaque prevalence in subjects with very-high cardiovascular risk in treatment with high-intensity statins with or without ezetimibe plus PCSK9i in real clinical practice. Methods: IMTc were measured at baseline and follow-up by 2D ultrasound. Lipid profile and prevalence of cardiovascular risk factors were collected in both visits. Results: Thirty-four subjects with familial hypercholesterolemia and 12 with a previous history of CVD were included. After a median follow-up of 15 years and a median time treatment with PCSK9i of 5 years, a median progression of IMTc of 0.00065 mm/year was observed in the common and internal carotid artery and 0.0098 mm/year in the carotid bulb. There was no difference in the number of plaques. In the same period, values of low-density lipoprotein cholesterol (LDLc) decreased by 77% (p<0.001), whereas high-density cholesterol (HDLc) increased by 5.9% (p=0.021). The prevalence of hypertension and diabetes increased from 16 to 57% and 7 to 33%, respectively. The variables associated with atherosclerosis progression were baseline IMTc, high LDLc, low HDLc and development of hypertension and diabetes mellitus, with the highest predictive value for the common carotid artery, R2= 0.55. Conclusions: Atherosclerosis progression in subjects receiving very intensive lipid-lowering treatment was lower than in the general population and was associated with LDLc reduction and HDLc increase.