Published online Sep 26, 2021. doi: 10.4330/wjc.v13.i9.472
Peer-review started: March 21, 2021
First decision: May 13, 2021
Revised: May 25, 2021
Accepted: July 21, 2021
Article in press: July 21, 2021
Published online: September 26, 2021
Core Tip: Intensive lipid-lowering therapies using ezetimibe and more recently proprotein convertase subtilisin kexin 9 inhibitors have improved clinical outcomes. Unselective application of these treatments is undesirable and unaffordable and, therefore, has been guided by low-density lipoprotein cholesterol level. Nonetheless, the residual risk in the post-statin era is markedly heterogeneous. Emerging data show that intensive lipid-lowering therapy produce larger absolute risk reduction in patients with polyvascular disease, post coronary artery bypass graft and diabetes. Notably, these clinical entities share similar phenotype of large burden of atherosclerotic plaques. Novel plaque imaging may aid decision making by identifying patients with propensity to develop lipid rich plagues at multi-vascular sites. Those patients may be suitable candidates for intensive lipid lowering treatment.