Several studies have investigated the association between non-statin lipid-lowering therapy and regression of atherosclerosis. However, these studies were mostly small and their results were not always robust. The objectives were: (1) to define if a dual lipid-lowering therapy (statin + non-statin drugs) is associated with coronary atherosclerosis regression, estimated by intravascular ultrasound (IVUS); (2) to assess the association between dual lipid-lowering-induced changes in low density lipoprotein cholesterol (LDL-C) and non-high-density-lipoprotein cholesterol (non-HDL-C) levels and atherosclerosis regression. A meta-analysis including trials of non-statin lipid-lowering therapy, reporting LDL-C, non-HDL-C and total atheroma volume (TAV) with a minimum of 6 months of follow-up was performed. The primary endpoint was defined as the change in TAV measured from baseline to follow-up, comparing groups of subjects on statins alone versus combination of statin and non-statin drugs. The random-effects model and meta-regression were performed. Eight eligible trials of non-statin lipid-lowering drugs (1759 patients) were included. Overall, the dual lipid-lowering therapy was associated with a significant reduction in TAV [− 4.0 mm3 (CI 95% -5.4 to − 2.6)]; I2 = 0%]. The findings were similar in the stratified analysis according to the lipid-lowering drug class (ezetimibe or PCSK9 inhibitors). In the meta-regression, a 10% decrease in LDL-C or non-HDL-C levels, was associated, respectively, with 1.0 mm3 and 1.1 mm3 regressions in TAV. These data suggests the addition of ezetimibe or PCSK9 inhibitors to statin therapy results in a significant regression of TAV. Reduction of coronary atherosclerosis observed with non-statin lipid-lowering therapy is associated to the degree of LDL-C and non-HDL-C lowering. Therefore, it seems reasonable to achieve lipid goals according to cardiovascular risk and regardless of the lipid-lowering strategy used (statin monotherapy or dual treatment).

中文翻译：

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非他汀类降脂治疗在冠状动脉粥样硬化消退中的作用：荟萃分析和荟萃回归。


几项研究调查了非他汀类降脂治疗与动脉粥样硬化消退之间的关联。然而，这些研究大多规模较小，其结果并不总是可靠的。目的是：（1）通过血管内超声（IVUS）评估，确定双重降脂疗法（他汀类药物+非他汀类药物）是否与冠状动脉粥样硬化消退相关； (2)评估双重降脂引起的低密度脂蛋白胆固醇(LDL-C)和非高密度脂蛋白胆固醇(non-HDL-C)水平变化与动脉粥样硬化消退之间的关联。进行了一项荟萃分析，包括非他汀类降脂治疗试验，报告 LDL-C、非 HDL-C 和总动脉粥样硬化体积 (TAV)，并进行至少 6 个月的随访。主要终点定义为从基线到随访期间测量的 TAV 变化，比较单独服用他汀类药物与服用他汀类药物和非他汀类药物组合的受试者组。进行了随机效应模型和元回归。纳入了 8 项符合条件的非他汀类降脂药物试验（1759 名患者）。总体而言，双重降脂治疗与 TAV 显着降低相关 [− 4.0 mm3 (CI 95% -5.4 至 − 2.6)]； I2 = 0%]。根据降脂药物类别（依折麦布或 PCSK9 抑制剂）进行的分层分析结果相似。在荟萃回归中，LDL-C 或非 HDL-C 水平降低 10% 分别与 TAV 回归 1.0 mm3 和 1.1 mm3 相关。这些数据表明，在他汀类药物治疗中添加依折麦布或 PCSK9 抑制剂可导致 TAV 显着消退。 非他汀类降脂治疗观察到的冠状动脉粥样硬化减少与 LDL-C 和非 HDL-C 降低程度相关。因此，根据心血管风险实现血脂目标似乎是合理的，无论采用何种降脂策略（他汀类药物单一疗法或双重治疗）。