**Abstract**

Lipid management remains the mainstay of cardiovascular disease prevention. Drugs that target cholesterol reduction, such as HMG-CoA reductase inhibitors (statins) and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, have shown significant mortality and morbidity benefit. Predominantly targeting low-density lipoprotein (LDL). These drugs have been indicated to reduce lipid composition and plaque proliferation. Total plaque burden and composition can now be assessed with noninvasive advanced cardiac imaging modalities. This chapter will address the components of atherosclerotic plaque as identified with coronary computed tomography angiography (CCTA) and review in detail the changes in plaque characteristics that may be responsible for reduction in cardiac events. These changes in plaque composition may help guide future management of cardiovascular disease, serving as an imaging biomarker for better risk stratification. Readers will gain a deeper understanding of plaque morphology with direct clinical applicability as well as an understanding of how noninvasive imaging can be utilized to assess plaque composition.

**Keywords:** coronary computed tomography angiography (CCTA), statin, PCSK9, low density lipoprotein (LDL), atherosclerotic plaque
