Coronary disease & ACSResearch article
Sex Differences in Coronary Atheroma Regression After Intensive Lipid-Lowering Therapy
- pooled individual-participant data from four serial intravascular ultrasound trials
- linear mixed-effects models adjusted for baseline plaque burden and trial
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 therapymen 1,987 · women 750
- 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
Main finding
As reported in the abstract
Baseline PAV · baseline
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. JACC Adv. Published 18 September 2026. doi:10.1016/j.jacadv.2026.103243
Summarised from the published abstract; every number is checked against it