Background It is recommended that Low dense lipoprotein-cholesterol (LDL-C) levels are reduced to less than 70mg/dL in patient with coronary heart disease. We sought to evaluate the effect of reduction of LDL-C level at coronary plaque composition by Intravascular ultrasound–Virtual Histology (IVUS-VH). Methods We analyzed the distal and proximal segment to the deployed stent using IVUS-VH, which had residual plaque, in 96 segments out of 62 patients (mean 59.9±11.4 years old, 46 males) during percutaneous coronary intervention and routine follow-up coronary angiography after 7.7±1.5 months. Study subjects were taken lipid lower agents (atorvastatin 10mg in 51 segments of 32 patients, rosuvastatin 10mg in 20 segments of 13 patients, pitavastatin 2mg in 25 segments of 17 patients) and divided into two groups according to LDL-C level measured at follow-up period. Group1=LDL-C < 70mg/dL, Group 2=LDL-C > 70mg/dL. results Total cholesterol (from 192.3±37.6mg/dL to 150.5±34.4mg/dL, p<0.001), triglyceride (from 166.5±102.1mg/dL to 154.3±87.7mg/dL, p=NS) and LDL-C (from 125.7±29.8mg/dL to 88.6±24.3mg/dL, p<0.001) were decreased and HDL-cholesterol (from 43.3±9.3mg/dL to 44.7±10.6mg/dL, p=NS) was increased during follow-up period. However, percent change of total cholesterol and LDL-C showed no significant difference among lipid lowering agents. In patient with LDL-C level less than 70mg/dL at follow-up period, percent fibrous volume (1.11% vs. -1.07%, p=NS) and percent dense calcium volume (-1.84% vs. 2.62%, p=NS) showed no significant change but percent fibrofatty volume (7.00% vs. -0.55%, p=0.015) and percent necrotic core volume (-6.26% vs. 0.19%, p=0.007) were more decreased than those with LDL-C level over 70mg/dL. Percent change of segment plaque burden showed no significant difference between two groups during follow-up period (-4.02% vs. 0.12%, p=NS). Conclusion This study showed that reduction of LDL-C level less than 70mg/dL, not 100mg/dL, is important in terms of the necrotic core of coronary plaque, which is a main component of vulnerable plaque.
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