Can we reverse atherogenesis with the eradication of toxic LDL-C? A comparative pooled analysis of selected therapies in quest of the revolutionary approach

Abstract Background The LDL-C is a toxic substrate of progressive atherosclerosis and the concept of the cumulative LDL-C exposure is proved in Mendelian trials. The eradication of LDL-C becomes a critical clinical target. Notwithstanding can we truly manage a related arterial remodeling that remains a question. Purpose The aim of the study was to estimate the atheroprotective disparities in the relevant lipid-lowering intravascular imaging studies in comparison with novel transient scaffolding and nanomedicine-based strategies. Methods This hypothesis-generating pooled subanalysis comparatively evaluates patterns of the regression of atherosclerosis in Caucasian and East Asian populations (EAP) in 38 intravascular ultrasound (IVUS) imaging studies (N=9,146). The analysis has revealed 7 so-called Classic (51.1% of the total analyzed population) studies (conducted by the group of Nicholls/ Nissen) with mostly Caucasian population, 18 clinical studies (31.7%) with White/ Caucasian population, and 13 trials (17.2%) with EAP (11 Japanese studies, 2 – South Korean, and 1 – Chinese). Results The regression of atherosclerosis was documented in 18 of 38 studies. A −1.67±5.99% mean absolute reduction of PB reported in all 38 studies with a −18.46±20.35% decrease of LDL cholesterol. The Glagovian threshold of a 40% plaque burden/ percent atheroma volume (PB) was achieved in one study, a NANOM-FIM trial (a 30.7% reduction of PB at 12 months, p