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Purpose of Review <p>This systematic review aimed to assess the impact of non-statin lipid-lowering therapies on imaging-defined features of carotid plaque vulnerability.</p> Recent Findings <p>Only studies assessing the effects of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors or ezetimibe met inclusion criteria for this review. Recent clinical trials and cohort studies suggest that PCSK9 inhibitors are associated with reductions in lipid-rich necrotic core volume, intraplaque neovascularization, and inflammatory activity. In contrast, ezetimibe has shown neutral or inconsistent effects, particularly when combined with low- or moderate-intensity statins.</p> <b>Summary</b> <p>PCSK9 inhibitors appear to contribute to early and multidimensional stabilization of vulnerable carotid plaques, whereas the evidence supporting ezetimibe remains limited. However, given the heterogeneity of imaging methods, study designs, and outcome definitions, further well-designed clinical studies with standardized imaging protocols are needed to better understand the role of these therapies in carotid plaque remodeling and stroke prevention.</p>

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Effect of non-statin Therapy on the Composition and Characteristics of Carotid Atherosclerotic Plaques: A Systematic Review

  • 期刊论文

  • 发表日期：

    2026年1月31日

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  • Fernando Garagoli,
  • Walter Masson,
  • Leandro Barbagelata

摘要

Purpose of Review

This systematic review aimed to assess the impact of non-statin lipid-lowering therapies on imaging-defined features of carotid plaque vulnerability.

Recent Findings

Only studies assessing the effects of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors or ezetimibe met inclusion criteria for this review. Recent clinical trials and cohort studies suggest that PCSK9 inhibitors are associated with reductions in lipid-rich necrotic core volume, intraplaque neovascularization, and inflammatory activity. In contrast, ezetimibe has shown neutral or inconsistent effects, particularly when combined with low- or moderate-intensity statins.

Summary

PCSK9 inhibitors appear to contribute to early and multidimensional stabilization of vulnerable carotid plaques, whereas the evidence supporting ezetimibe remains limited. However, given the heterogeneity of imaging methods, study designs, and outcome definitions, further well-designed clinical studies with standardized imaging protocols are needed to better understand the role of these therapies in carotid plaque remodeling and stroke prevention.