Serial Coronary Plaque Composition After Inclisiran Initiation Assessed by Automated CCTA: A Retrospective Pilot Study

Abstract

Background/Objectives : Inclisiran provides durable low-density lipoprotein cholesterol (LDL-C) lowering, but serial coronary plaque composition after treatment initiation remains incompletely characterized. This study evaluated temporal plaque changes using automated coronary computed tomography angiography (CCTA). Methods : In this uncontrolled, retrospective, observational pilot study, consecutive patients who initiated inclisiran between 1 January 2024 and 29 April 2026 were screened. A random-intercept mixed-effects model included every eligible quantitative plaque observation obtained by the prespecified data cutoff. Results : Of the 230 screened patients, 215 contributed 468 plaque observations (baseline, n = 186; 3 months, n = 196; 15 months, n = 86); 74 had all three examinations. The LDL-C levels decreased from 117.4 mg/dL (95% confidence interval [CI], 113.3-121.6) to 45.9 mg/dL (39.5-52.3) at 15 months. No significant time effect was detected for the total plaque volume ( p = 0.713). Low-density non-calcified plaque (LDNC) decreased from 27.3 mm 3 (23.1-31.6) to 22.7 mm 3 (18.0-27.4; overall p = 0.0035), whereas calcified plaque increased from 56.5 mm 3 (45.6-67.3) to 67.1 mm 3 (55.9-78.2; p < 0.0001). The adjusted baseline-to-15-month differences were -4.64 mm 3 for LDNC (95% CI, -7.54 to -1.74; Bonferroni-adjusted p = 0.0052) and +10.60 mm 3 for calcified plaque (6.60-14.60; adjusted p < 0.0001). In the tube voltage-adjusted sensitivity analysis of 107 patients and 278 observations, these findings were maintained. Conclusions : Patients initiating inclisiran showed temporal changes in attenuation-defined plaque composition. The uncontrolled design, incomplete acquisition data in the expanded cohort, and technical variability preclude causal or histologic interpretation.

Abstract of "Serial Coronary Plaque Composition After Inclisiran Initiation Assessed by Automated CCTA: A Retrospective Pilot Study" by Kawada K, Suzuki M, Mochizuki J et al., https://doi.org/10.3390/diagnostics16183009, used under its Creative Commons Attribution license (CC-BY); markup removed, otherwise unmodified.