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Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL)
Nissen SE et al. JAMA 2004;291:1071-1080.
654 patients with symptomatic CAD with angiographic stenosis >20% and LDL-C 125–210 mg/dL; 502 with evaluable follow-up
Randomization to pravastatin 40 mg/d or atrovastatin 80 mg/d for 18 months
IVUS performed at baseline and 18 months
Primary endpoint:  percent change in atheroma volume assessed with IVUS
Baseline Characteristics:  REVERSAL
Nissen SE et al. JAMA 2004;291:1071-1080.
REVERSAL:  Primary and Secondary Endpoints— Change in Atheroma Volume Assessed by IVUS
Change from Baseline, %
p=.02
p=.02
p<.001
2.7
–0.4
4.4
–0.9
Nissen SE et al. JAMA 2004;291:1071-1080.
p<.001
1.6
0.2
p=.01
p=.001
1° endpoint: Percent change in atheroma volume
Total atheroma volume
Change in percent atheroma volume
p=.98
p=.72
p=.18
REVERSAL:  Lipid and CRP Changes
Change from Baseline, %
–34.1
Nissen SE et al. JAMA 2004;291:1071-1080.
p<.001
TC
LDL-C
HDL-C
TG
Apo B-100
CRP
–18.4
–25.2
–46.3
5.6
2.9
–6.8
–20.0
–22.0
–39.1
–5.2
–36.4
p<.001
p=.06
p<.001
p<.001
p<.001
REVERSAL:  Final Lipids on Treatment
Mg/dL
Nissen SE et al. JAMA 2004;291:1071-1080.
LDL-C
110.4
Apo B-100
TG
HDL-C
78.9
118.1
91.8
165.8
148.4
44.6
43.1
REVERSAL:  Effects on LDL-C
Nissen SE et al. JAMA 2004;291:1071-1080.
LDL-C was reduced to a mean of 110 mg/dL with pravastatin 40 mg and 79 mg/dL with atorvastatin 80 mg
ATP III goal of LDL-C <100 mg/dL was achieved by 65% of pravastatin patients and 97% of atorvastatin patients