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To summarize the impact of lowering LDL-C on plaque progression, microstructures and compositions.Low-density lipoprotein cholesterol (LDL-C) is a major therapeutic target to prevent atherosclerotic cardiovascular disease. Intravascular imaging has elucidated antiatherosclerotic effects of lowering LDL-C in vivo. Intensive control of LDL-C with a statin has been shown to slow plaque progression and induce its regression if very low LDL-C level is achieved. This therapeutic approach has been also demonstrated to modulate plaque microstructures and compositions. These mechanistic insights on intravascular imaging support the benefit of lowering LDL-C in achieving better cardiovascular outcomes.Lowering LDL-C level has become the first-line therapy in the primary and secondary prevention settings. The effects of lowering LDL-C on plaque progression, microstructures and compositions will be reviewed in this article.