Effect of Atorvastatin (80 mg/day) Versus Pravastatin (40 mg/day) on Arterial Remodeling at Coronary Branch Points (from the REVERSAL Study)

The effect of moderate and intensive lipid lowering on plaque progression and arterial remodeling at coronary branch points was investigated. Intensive (+1 ± 19.6%), but not moderate (+4.1 ± 15.1%), lipid lowering prevented an increase in plaque area at the branch points. The 2 strategies were associated with increased areas of the lumen (+7.6% to 9.4%) and external elastic membrane (+9.6% to 10.8%). In contrast, there was no significant change in plaque, lumen, and/or external elastic membrane areas at the nonbranch point site. These results suggest that intensive lipid lowering can have a dramatic effect on atheroma-prone regions and that remodeling in response to changes in plaque is a heterogenous process.