Is low-level laser therapy (LLLT) effective as a primary treatment for atherosclerosis?

Low-Level Laser Therapy and Atherosclerosis

Low-level laser therapy (LLLT) is not recommended as a primary treatment for atherosclerosis, as there is no credible evidence supporting its efficacy for this indication, and established lipid-lowering therapies with proven mortality and morbidity benefits should be used instead.

Evidence Base and Treatment Standards

The current evidence for LLLT in atherosclerosis is limited to outdated research from the 1980s-2000s focusing on experimental percutaneous laser ablation techniques for obstructing atheroma 1, 2. These early studies explored direct vaporization of plaque and were associated with high complication rates including mural perforation 1. No modern, high-quality randomized controlled trials demonstrate that LLLT reduces cardiovascular morbidity, mortality, or improves quality of life in patients with atherosclerotic disease.

Established Evidence-Based Treatment

For patients with established atherosclerotic cardiovascular disease (ASCVD), the International Lipid Expert Panel (ILEP) 2024 guidelines provide clear, evidence-based recommendations 3:

Primary Treatment Approach

• Upfront combination lipid-lowering therapy is recommended for very high-risk ASCVD patients, consisting of high-intensity statin plus ezetimibe as fixed-dose combination 3
• This approach reduces cardiovascular events (HR 0.81; 95% CI 0.74–0.88; p < 0.001; NNT = 45) compared to statin monotherapy 3
• Target LDL-C levels: <55 mg/dL for very high-risk patients, <40 mg/dL for extremely high-risk patients 3

Treatment Intensification

• For extremely high-risk patients not achieving targets, add PCSK9 inhibitors (monoclonal antibodies or inclisiran) or bempedoic acid to achieve triple or quadruple therapy 3
• These agents reduce LDL-C by >85% and have demonstrated cardiovascular outcome benefits 3

Clinical Context

• Atherosclerotic disease causes over 9 million deaths annually, with ischemic heart disease being the leading cause of death globally (108.7/100,000) 3
• Only 20-22% of very high-risk patients currently achieve guideline-recommended LDL-C targets, representing a massive treatment gap 3

Why LLLT Is Not Appropriate

LLLT lacks the fundamental evidence required for atherosclerosis treatment:

• No randomized controlled trials demonstrating reduction in myocardial infarction, stroke, or cardiovascular death 1, 2
• No evidence of plaque regression or stabilization with modern LLLT techniques
• The historical laser approaches for atherosclerosis involved high-energy ablative techniques, not the low-level photobiomodulation used in contemporary LLLT 1

While LLLT shows some promise in other applications like wound healing and sports medicine recovery 4, 5, these mechanisms (cellular metabolism modulation, reduced inflammation) have not translated to meaningful cardiovascular outcomes in atherosclerosis.

Clinical Pitfall to Avoid

Do not delay or substitute proven lipid-lowering therapy with unproven interventions like LLLT. Every month of elevated LDL-C exposure increases lifetime cardiovascular risk 3. Patients with ASCVD require immediate initiation of maximally tolerated statin therapy combined with ezetimibe, with monitoring at 4-6 weeks and intensification to PCSK9 inhibitors or bempedoic acid if targets are not achieved 3, 6, 7.

The median time to statin discontinuation is only 15 months 3, making it critical to use evidence-based combination therapy from the outset rather than pursuing ineffective alternatives that waste valuable treatment time.