Serial Coronary CTA for Monitoring Response to Lipid-Lowering Therapy: A Narrative Review

Purpose of the Review: This review summarizes current evidence on the use of serial coronary computed tomography angiography (CCTA) to monitor the effects of lipid-lowering therapies (LLTs)—including statins, PCSK9 inhibitors, and icosapent ethyl—on coronary plaque regression. Recent Findings: Serial CCTA enables detailed anatomic assessment of plaque characteristics including luminal stenosis, total plaque volume, calcified plaque, non-calcified plaque, and high-risk plaque features. Functional imaging with Fractional Flow Reserve from Computed Tomography and inflammatory assessment via perivascular fat attenuation index and pericoronary adipose tissue improve disease characterization. Together, these complementary tools provide a comprehensive evaluation of both the structural and biological aspects of coronary atherosclerosis, enhancing risk stratification and monitoring of therapeutic response to LLT. Summary: Serial CCTA is a valuable noninvasive tool for monitoring the effects of LLTs on coronary plaque progression aiding in risk stratification. However, wider clinical adoption is limited by cost, radiation exposure, contrast-related risks, and technical challenges in some patient populations.