The Study
Lipid plaque density index as a phenotypic plaque feature which benefits from achieving LDL-C <55 mg/dL: Observations from the REASSURE-NIRS Multi-center Registry
This study looked at people who already had heart disease and saw that those with a certain type of fatty buildup in their arteries tended to do better when their bad cholesterol was very low. But it didn’t make anyone change their medicine — it just watched what happened. So we can’t say the low cholesterol caused the better outcome — maybe those people were just healthier in other ways.
Analysis score
Maximum 72 for a cohort study.
Where the score came from
Some heart plaques are full of oily fat (high LPDI), others aren't. This study found that lowering cholesterol very low (below 55 mg/dL) only helps prevent heart attacks in people whose plaques are oily.
Where does this study sit?
Reviews of RCTs (Meta-analyses)
Max 100Randomized Trials
Max 90Reviews of Cohort Studies
Max 85Cohort Studies
Max 72Reviews of Case-Control Studies
Max 63Case-Control Studies
Max 58Cross-Sectional & Case Series
Max 50Expert Opinion
Max 540 / 100
Quality score
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
Key takeaways
Summary
Based on the study abstract and findings.
- 1Yes — this suggests doctors might use plaque scans to decide who really needs ultra-low cholesterol targets, avoiding unnecessary treatment for others.
- 233% fewer heart attacks in patients with oily plaques (LPDI ≥7.65) when LDL was below 55 mg/dL.
- 3No benefit in patients with less oily plaques (LPDI <7.65).
Score breakdown, methodology, conflicts of interest, evidence analysis & raw study data
Publication
Journal
European Heart Journal
Year
2025
Authors
H. Nishido, Y. Kataoka, K. Murai, T. Iwai, M. Fujino, S. Yoneda, K. Takagi, K. Nakao, F. Otsuka, S. Kitahara, I. Takamisawa, K. Nishihara, Y. Asaumi, S. Nicholls, T. Noguchi
Related Content
Claims (6)
In patients with established atherosclerotic cardiovascular disease, reducing LDL cholesterol to below 55 mg/dL lowers the rate of major heart events by 33%, improves kidney function, and does not increase safety risks.
In patients with coronary artery disease and high plaque density, having LDL cholesterol below 55 mg/dL is linked to fewer heart attacks, cardiac deaths, and need for repeat heart procedures.
The lipid plaque density index (LPDI) is a calculated measure from medical imaging that identifies patients with coronary artery disease who have a higher likelihood of experiencing cardiovascular events, based on their LDL cholesterol levels.
In patients with coronary artery disease, those with LDL cholesterol below 55 mg/dL are more often prescribed high-intensity statins, regardless of the amount of plaque in their arteries.
For patients with coronary artery disease and low lipid plaque density, lowering LDL cholesterol below 55 mg/dL does not reduce the occurrence of major cardiovascular events such as heart attack or stroke.
In people with high levels of lipid-rich plaque in their arteries, lowering LDL cholesterol below 55 mg/dL reduces the risk of heart attacks and strokes. In people with low levels of such plaque, lowering LDL cholesterol to this level does not reduce cardiovascular risk.
Not medical advice. For informational purposes only. Always consult a qualified healthcare professional before making health decisions.