Effect of pharmacologic anti-atherosclerotic therapy on carotid intraplaque neovascularization: A systematic review

Research output: Contribution to journalReviewResearchpeer-review

  • Edward Cui
  • Georgia Kersche
  • Nicholas Grubic
  • Marie France Hétu
  • Stephen C. Pang
  • Sillesen, Henrik
  • Amer M. Johri

Intraplaque neovascularization (IPN), a key feature of vulnerable carotid plaque, is associated with adverse cardiovascular (CV) events. Statin therapy has been shown to diminish and stabilize atherosclerotic plaque, but its effect on IPN is uncertain. This review investigated the effects of common pharmacologic anti-atherosclerotic therapies on carotid IPN. Electronic databases (MEDLINE, EMBASE and Cochrane Library) were searched from inception until July 13, 2022. Studies evaluating the effect of anti-atherosclerotic therapy on carotid IPN among adults with carotid atherosclerosis were included. Sixteen studies were eligible for inclusion. Contrast-enhanced ultrasound (CEUS) was the most common IPN assessment modality (n=8), followed by dynamic contrast-enhanced MRI (DCE-MRI) (n=4), excised plaque histology (n=3) and superb microvascular imaging (n=2). In fifteen studies, statins were the therapy of interest and one study assessed PCSK9 inhibitors. Among CEUS studies, baseline statin use was associated with a lower frequency of carotid IPN (median OR = 0.45). Prospective studies showed regression of IPN after 6-12 months of lipid-lowering therapy, with more regression observed in treated participants compared to untreated controls. Our findings suggest that lipid-lowering therapy with statins or PCSK9 inhibitors is associated with IPN regression. However, there was no correlation between change in IPN parameters and change in serum lipids and inflammatory markers in statin-treated participants, so it is unclear whether these factors are mediators in the observed IPN changes. Lastly, this review was limited by study heterogeneity and small sample sizes, so larger trials are needed to validate findings.

Original languageEnglish
JournalJournal of Clinical Lipidology
Issue number3
Pages (from-to)315-326
Number of pages12
Publication statusPublished - 2023

Bibliographical note

Publisher Copyright:
© 2023

    Research areas

  • Carotid plaque, Contrast-enhanced ultrasound, Dynamic contrast-enhanced MRI, Intraplaque neovascularization, PCSK9 inhibitor, Statin, Superb microvascular imaging

ID: 360065510