Recent publications on Residual Risk

This post hoc pooled analysis of three randomized trials of serial coronary intravascular ultrasound (REVERSAL, ASTEROID and SATURN) suggests that women with coronary disease derive greater benefit from high intensity statin therapy than male patients. The analysis evaluated data from 451 women and 1190 men. On-treatment levels of mean low-density lipoprotein cholesterol [LDL-C] (68 ± 24 vs. 67 ± 22 mg/dl) and apolipoprotein B (77 ± 23 vs. 76 ± 20 mg/dL) were similar in both sexes, although triglycerides were higher in women than men [median (interquartile range):122 (95, 158) vs. 114 (89, 154) mg/dl, p=0.012]. Additionally, C-reactive protein was also higher in women than men [1.7 (0.9, 3.8) vs. 1.1 (0.6, 2.7) mg/l, p < 0.001]. While women had significantly lower baseline percent atheroma volume (PAV) than men (34.8 ± 8.7 vs. 38.3 ± 8.8%, p < 0.001), they derived significantly greater regression in atheroma (Change in PAV -1.07 ± 0.26 vs. -0.66 ± 0.23%, p=0.02), especially with on-treatment levels of LDL-C <64 mg/dl, apolipoprotein B <73 mg/dl, and non-high-density lipoprotein cholesterol [non-HDL-C] <88.8 mg/dl. Furthermore, these apparent sex-related differences in plaque regression with high intensity treatment seem to relate more to lower achieved atherogenic lipoprotein levels (as typified by LDL-C and non-HDL-C) than lower inflammatory levels (as typified by C-reactive protein). These findings emphasize the need for aggressive lipid lowering strategies in women with established atherosclerosis.