Table 3. Studies assessing quantitative plaque changes on serial CCTA in response to therapies.
| Study | Patients (n) | Population | Study type | Intervention (groups) | Software | Plaque measures | Follow up* | Results | |
|---|---|---|---|---|---|---|---|---|---|
| Statin | |||||||||
| Hoffmann et al., 2010 [86] | 63 | Serial CCTA studies | Retrospective observational | Statin* | Vitrea | TP, NCP, MP, CP | 25 months | Statins significantly slowed the growth of NCP but did not significantly affect the growth rate of MP or CP | |
| Inoue et al., 2010 [87] | 32 | Suspected CAD, no baseline statin | Prospective observational | Statin 24 | SUREPlaque | LAP, intermediate, calcified based on HU | 12 months | Statin treatment results in significant reduction of TP and LAP volumes | |
| No statin 8 | |||||||||
| Zeb et al., 2013 [88] | 100 | No history of CAD and serial CCTA at an interscan interval of 1 year | Retrospective observational | Statin 60 | Vitrea | TP, NCP, MP, CP, LAP | 406 days | Mean plaque volume difference between statin and non-statin users was statistically significant for both LAP and NCP volumes | |
| No statin 40 | |||||||||
| Lo et al., 2015 [89] | 40 | HIV-infected patients on stable ART, and LDL-C between 70–130 mg/dL | Prospective randomized | Atorvastatin 19 | Aquarius iNtuition, Terarecon | TP, NCP | 1 year | Atorvastatin reduced NCP volume relative to placebo | |
| No statin 21 | |||||||||
| Auscher et al., 2015 [90] | 96 | Acute MI patients | Prospective randomized | Intensive statin 48 | QAngio | TP, NC, FF, Fibrous, CP | 1 year | Plaque composition changed over 1 year with an increase in total dense calcium volume in the intensive care group and a decreased in the usual care group | |
| Standard statin 48 | |||||||||
| Li et al., 2016 [91] | 206 | Suspected CAD | Prospective observational | Intensive 55 | CardIQ Xpress 2.0 | LAP, TP, PPV | 18 months | LAP volume, TP volume, and PPV showed significant regression among intensive-statin compared with no-statin group | |
| Moderate 85 | |||||||||
| No statin 66 | |||||||||
| Nou et al., 2016 [92] | 40 | HIV-infected patients on stable ART with subclinical coronary atherosclerosis and LDL-C less than 130 mg/dL | Prospective randomized | Atorvastatin 19 | - | TP, NCP, CP | 12 months | Change in oxLDL significantly correlated with changes in NCP volume, TP volume | |
| Placebo 21 | |||||||||
| Lee et al., 2018 [49] | 1255 | serial CCTA at an interscan interval of ≥ 2 years | Prospective observational | Statin naïve 474 | QAngio | PV, CP NCP, LAP, FF, Fibrous | 3.4 years | Lesions in statin-taking patients displayed a slower rate of overall PAV progression but more rapid progression of calcified PAV | |
| Statin taking 781 | |||||||||
| Smit et al., 2020 [93] | 202 | Suspected CAD | Prospective observational | Statin (+) 161 | QAngio | TP, CP, NCP | 6.4 years | Statin use showed an independent association with annual progression of CP. Statin use was borderline significantly associated with a reduced progression of NCP | |
| Statin (-) 41 | |||||||||
| Foldyna et al., 2020 [94] | 40 | HIV-infected patients | Prospective randomized | Atorvastatin 19 | Aquarius iNtuition, TeraRecon | TP, CP, FF, Fibrous | 12 months | Statins suppressed progression of fibrotic plaque, with a trend towards reducing fatty plaque and no significant effect on CP | |
| Placebo 21 | |||||||||
| van Rosendael et al., 2021 [48] | 857 | PARADIGM | Prospective observational | Statin (+) 548 | QAngio | LAP, FF, Fibrous, low-density calcium, high density calcium | 3.4 years | Statin therapy was associated with volume decreases in LAP and FF plaque and greater progression of high-density CP and 1K plaque | |
| Statin (-) 309 | |||||||||
| Other lipid lowering treatment | |||||||||
| Alfaddagh et al., 2017 [96] | 285 | Stable CAD on statins | Prospective randomized | Omega-3 ethyl ester 143 | SUREPlaque | TP, CP, NCP, FF, Fibrous | 30 months | No difference was observed in NCP volume, between the 2 treatment groups | |
| Control 142 | |||||||||
| Budoff et al., 2020 [98] | 80 | Patients with stenoses with ≥ 20% persistently elevated TG levels | Prospective randomized | IPE 31 | QAngio | TP, NCP, LAP, FF, CP | 18 months | IPE demonstrated significant regression of LAP | |
| Placebo 37 | |||||||||
| Motoyama et al., 2022 [95] | 210 | ACS patients | Retrospective observational | No EPA/DHA 69 | QAngio | TP, CP, NCP, LAP, Fibrous, FF | 24 months | Addition of high-dose EPA to statin therapy was associated with a lower rate of plaque progression | |
| Low dose EPA + DHA 51 | |||||||||
| High dose EPA + DHA 20 | |||||||||
| High dose EPA alone 70 | |||||||||
| Baumann et al., 2022 [97] | 23 | Patients underwent CCTA | Prospective observational | PCSK 9 inhibitor | Syngo VE36A | TP, CP, NCP | 1 year | TPV, CPV, NCPV, lumen volume, and functional plaque parameters did not change significantly | |
| Pérez et al., 2023 [99] | 104 | Familial hypercholesterolemia without ASCVD | Phase IV clinical trial | Alirocumab, PCSK9 inhibitor | QAngio | TP, CP, Fibrous, FF, NC | 78 weeks | Alirocumab + high-intensity statin induced increased calcified, fibrous plaque, and decreased FF, necrotic plaque | |
| Biology therapy in psoriasis patients | |||||||||
| Elnabawi et al., 2019 [100] | 290 | Severe psoriasis | Prospective observational | TNF-a, IL 12/23, IL 17 inhibitor vs. placebo | QAngio | TP, NCP, CP, LAP | 1 year | Biology therapy is associated with decreased NCP, FF, necrotic burden | |
| Choi et al., 2020 [101] | 209 | Biologic naïve psoriasis patients | Prospective observational | Mild to moderate psoriasis 212 | vascuCAP | LRNC | 1 year | Biologic therapy had a reduction in LRNC | |
| Severe psoriasis 77 | |||||||||
| Other medication | |||||||||
| Budoff et al., 2017 [102] | 138 | Symptomatic hypogonadism | Prospective randomized | Testosterone treatment 73 | QAngio | TP, NCP, LAP, FF, CP | 1 year | Treatment with testosterone gel for 1 year compared with placebo was associated with a significantly greater increase in NCP volume | |
| Placebo 65 | |||||||||
| Lee et al., 2017 [103] | 40 | DM patients | Prospective randomized | Sarpogrelate + aspirin: 20 | Brilliance Workspace V4.5; Philips Healthcare | TP, NCP, CP | 6 months | Sarpogrelate treatment may decrease coronary artery plaque volume, particularly the NCP, in DM patients | |
| Aspirin: 20 | |||||||||
| Matsumoto et al., 2017 [104] | 54 | Recent ACS patients | Prospective randomized | One of 3 VIA 2291 doses (25 mg, 50 mg, 100 mg) or placebo | SUREPlaque, | LAP, FF, Fibrous, dense calcium | 6 months | VIA-2291 resulted in slowed PP compared with placebo across different plaque subtypes in patients with recent ACS | |
| Vaidya et al., 2018 [105] | 80 | Recent ACS (< 1 month) | Prospective observational | Colchicine + OMT 40 | GE Advantage workstation v4.5 | CP, NCP, LAP, TAV | 12.6 months | Colchicine therapy significantly reduced LAPV | |
| OMT alone 40 | |||||||||
| Shaikh et al., 2020 [106] | 66 | DM patients | Prospective randomized | Aged garlic extract 37 | QAngio | TP, NCP, CP, LAP | 1 year | Aged garlic extract group exhibited a statistically significant regression in normalized LAP | |
| Placebo 29 | |||||||||
| Aldana-Bitar et al., 2023 [107] | 74 | Patients with nonvalvular atrial fibrillation using apixaban or rivaroxaban | Prospective randomized | Apixaban 29 | AW 4.6 GE Healthcare | TP, CP, NCP | 12 months | Significantly lower CP progression in the apixaban group | |
| Rivaroxaban 45 | |||||||||
| Heinsen et al., 2023 [108] | 204 | Asymptomatic DM patients | Prospective observational | Liraglutide (+) 55 | QAngio | TP, CP, Fibrous, FF, NC | 1 year | A greater increase in fibrous plaque volume was seen in the Lira+ vs. the Lira- group | |
| Liraglutide (-) 149 | |||||||||
*The mean or median values.
CCTA = coronary computed tomography angiography, TP = total plaque, NCP = noncalcified plaque, MP = mixed plaque, CP = calcified plaque, CAD = coronary artery disease, LAP = low attenuation plaque, HU = Hounsfield unit, HIV = human immunodeficiency virus, ART = antiretroviral therapy, LDL-C = low density lipoprotein cholesterol, MI = myocardial infarction, NC = necrotic core, FF = fibro-fatty, PPV = percent plaque volume, oxLDL = oxidized LDL, PAV = percentage atheroma volume, IPE = icosapent ethyl, ACS = acute coronary syndrome, EPA = epicosapentaenoic acid, DHA = docosahexaenoic acid, ASCVD = atherosclerotic cardiovascular disease, LRNC = lipid rich necrotic core, DM = diabetes mellitus, OMT = optimal medical therapy