Can Combining Cholesterol Drugs Reduce Heart Artery Plaque More Effectively?

A clinical trial has found that combining cholesterol-lowering medicines can reduce plaque buildup in heart arteries more effectively than using high-dose statins alone.

Published in JAMA Cardiology, the study examined whether lowering low-density lipoprotein (LDL), commonly known as bad cholesterol, could help reduce existing plaque deposits in people with coronary artery disease.

The FLOWPROMOTE trial involved 104 adults in Denmark with stable chest pain and significant coronary artery disease.

Participants had not previously taken statins and received treatment for 18 months.

Researchers divided them into two groups. One group received 40 mg of atorvastatin daily, while the other took a combination of 40 mg of rosuvastatin and 10 mg of ezetimibe.

The combination treatment reduced LDL cholesterol levels by 65%, compared with 38% among those taking atorvastatin alone.

Average LDL levels in the combination group dropped from 127.4 mg/dL to 42.5 mg/dL.

The findings showed a greater reduction in coronary artery plaque among patients receiving the combination therapy. Their total plaque volume fell by 21.1%, compared with a 13.6% decline in the atorvastatin group.

The reduction was particularly noticeable in noncalcified plaque, which contains softer, fatty deposits and is more vulnerable to rupture. These deposits decreased by 28.2% in the combination group, compared with 20% in the other group.

Plaque volume declined in 90% of participants receiving combination treatment, compared with 75% of those taking atorvastatin alone.

Calcified plaque increased modestly in both groups, potentially reflecting changes associated with plaque stabilisation.

Atherosclerosis develops when cholesterol and other substances accumulate along artery walls, narrowing blood vessels and restricting blood flow. It increases the risk of heart attacks and strokes.

The researchers said the findings demonstrate that intensive cholesterol reduction can help reverse some existing plaque buildup.

Further research is required to determine whether these changes translate into fewer heart attacks and other cardiovascular complications.

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