Sex Differences in Coronary Atheroma Regression After Intensive Lipid-Lowering Therapy: A Pooled Analysis
Authors' conclusion
Women undergoing clinically indicated procedures present with paradoxically less extensive atheroma and more favorable plaque composition despite higher cardiovascular risk burden. They experience greater coronary plaque regression than men after intensive lipid-lowering, especially when LDL-C is below 55 mg/dL, with similar plaque stabilization.
Study context
- Population
- Participants of the REVERSAL, ASTEROID, SATURN, and GLAGOV trials receiving intensive lipid-lowering therapy
- Participants
- 2,737 participants
- Comparison
- Sex-specific changes in percent atheroma volume (PAV), total atheroma volume (TAV), and plaque composition after intensive lipid-lowering
- Womenn = 750
- Menn = 1,987
- Outcome
- Baseline PAV
- Follow-up
- Baseline
Methodological detailslinear mixed-effects models adjusted for baseline plaque burden and trial
- Linear mixed-effects models adjusted for baseline plaque burden and trial
Main finding
As reported in the abstract
Further findings
Baseline virtual histology composition
Fibro-fatty volume (median) women 13.7 mm³ · men 34.3 mm³
Necrotic core volume (median) women 7.7 mm³ · men 13.1 mm³
Fibrous content (mean)
Least-squares-mean
| Outcome | Women | Men |
|---|---|---|
| Change in PAV · median follow-up of 20.7 months | −0.25% | −0.05% |
- Change in PAV: similar achieved low-density lipoprotein-cholesterol (LDL-C) (∼70 mg/dL)
Change in PAV · median follow-up of 20.7 months
- Women showed greater regression in PAV and TAV, with similar plaque stabilization
- Female sex independently predicted PAV regression, most pronounced in women achieving LDL-C <55 mg/dL
Original publication
Sex Differences in Coronary Atheroma Regression After Intensive Lipid-Lowering Therapy: A Pooled Analysis. JACC Adv. Published 18 September 2026. doi:10.
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