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- 幻灯介绍：
Reversing Atherosclerosis with Aggressive Lipid Lowering
Presented at
American Heart Association
Scientific Sessions 2003
Presented By Steven E. Nissen, M.D.
REVERSAL Trial
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
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
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
REVERSAL Trial
Percent Reduction in CRP
p<0.001
AHA 2003, Orlando, FL
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