Abstract 4359239: Impact of Escalating Lipid-Lowering Therapy on Coronary Artery Calcium Progression and Lipid Biomarkers

Background: Coronary artery calcium (CAC) progression is a surrogate marker of atherosclerosis; however, the extent to which it can be modified by intensive lipid-lowering therapy remains unclear. This study aimed to evaluate the impact of escalating lipid-lowering strategies on CAC progression and lipid parameters. Methods: In this retrospective analysis, we included individuals who underwent coronary calcium score scans at least 12 months apart and had corresponding lipid biomarker data available. Participants were categorized into three treatment groups: statin monotherapy, statin plus icosapent ethyl (IPE), and triple therapy with statin, IPE, and a PCSK9 inhibitor. We compared the median annual percent change in CAC and the mean change in lipid biomarker levels across the groups. Results: A total of 123 subjects (mean age 68.2 ± 8.7 years; 72% male) were included, with an average follow-up of 2.6 ± 1.0 years. After adjusting for confounding factors, including baseline CAC score, the median annual CAC progression rate was highest in the statin-only group (~14%), lower in the statin + IPE group (~12%), and lowest in the triple therapy group (~7%), p-value = 0.029. The triple therapy group also demonstrated the greatest reductions in total cholesterol (−45 mg/dL; p < 0.001) and LDL-C (−44 mg/dL; p < 0.001), compared to modest changes in other groups. Mean triglycerides also decreased in triple therapy compared to statin or dual therapy, but did not reach statistical significance. Conclusion: Escalation of lipid-lowering therapy, particularly with the addition of PCSK9 inhibition, was associated with a significant attenuation of CAC progression and marked improvement in lipid biomarkers. These findings support the use of intensive lipid-lowering strategies to mitigate atherosclerotic progression.