ArticleJACC. Advances2026
Sex Differences in Coronary Atheroma Regression After Intensive Lipid-Lowering Therapy: A Pooled Analysis.
Article in JACC. Advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
6 authors.
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Abstract
backgroundIntensive lipid-lowering therapy with high-intensity statins, with or without proprotein convertase subtilisin/kexin type 9 inhibitors, reduces coronary plaque burden. However, whether men and women experience similar atheroma regression and plaque compositional changes remains uncertain.
objectivesThe objective of the study was to quantify sex-specific changes in percent atheroma volume (PAV), total atheroma volume (TAV), and plaque composition after intensive lipid-lowering, using pooled individual-participant data from four serial intravascular ultrasound trials.
methodsData from REVERSAL, ASTEROID, SATURN, and GLAGOV trials (N = 2,737; 1,987 men, 750 women) were analyzed centrally. Over a median follow-up of 20.7 months, annualized changes in PAV, TAV, and virtual histology components were compared using linear mixed-effects models adjusted for baseline plaque burden and trial.
resultsWomen were older with higher rates of hypertension and diabetes but presented with lower baseline PAV (mean: 34.5% vs 38.5%) and less extensive plaque composition abnormalities, even when normalized for plaque burden. Virtual histology analysis revealed women had lower baseline fibro-fatty volume (median: 13.7 vs 34.3 mm
conclusionsWomen 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.
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