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A Reversing Atherosclerosis with Aggressive Lipid Lowering

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Slide 1 - Reversing Atherosclerosis with Aggressive Lipid Lowering Presented at American Heart Association Scientific Sessions 2003 Presented By Steven E. Nissen, M.D. REVERSAL Trial
Slide 2 - Aggressive lipid lowering strategy Atorvastatin (80 mg) n=253 Endpoints (follow-up 18 months): Primary – Percent change in atheroma volume on IVUS between baseline and 18 month follow-up Secondary – Absolute change in atheroma volume; change in the percent obstructive volume REVERSAL Trial AHA 2003, Orlando, FL 502 symptomatic coronary artery disease patients with elevated LDL Randomized, double-blind, multicenter Moderate lipid-lowering strategy Pravastatin (40 mg) n=249
Slide 3 - REVERSAL Trial LDL at follow-up p<0.001 AHA 2003, Orlando, FL mg/dL Total-cholesterol at follow-up p<0.001 mg/dL HDL at follow-up p=0.06 mg/dL
Slide 4 - REVERSAL Trial Change in atheroma volume p=0.02 for change between atorvastatin vs pravastatin Change in percent obstruction volume p=0.0002 for change between atorvastatin vs pravastatin AHA 2003, Orlando, FL
Slide 5 - REVERSAL Trial Percent Reduction in CRP p<0.001 AHA 2003, Orlando, FL
Slide 6 - REVERSAL Trial Among patients with symptomatic CAD and elevated LDL, use of an aggressive lipid-lowering strategy through treatment with 80-mg atorvastatin was associated with a reduction in percent change in atheroma volume compared with a more moderate lipid-lowering strategy through treatment with 40-mg pravastatin Primary endpoint used an IVUS endpoint and the trial was not designed to assess mortality or clinical events, and a much larger trial would be needed to assess superiority of one statin over another for these endpoints AHA/ACC guidelines currently recommend statin therapy (as a class) for reduction of LDL levels to <100 mg/dL