Key result
Female sex is linked to ~0.2% greater coronary atheroma regression on intensive lipid-lowering therapy.
Why the study?
Intensive lipid-lowering therapy reduces coronary plaque burden, but whether men and women experience similar atheroma regression and plaque compositional changes remained uncertain.
Does female sex compared with male sex result in greater coronary atheroma regression and plaque compositional changes after intensive lipid-lowering therapy in patients with established coronary artery disease?
Meta-Analysis (n=2,737)
Core laboratory personnel, blinded to treatment allocation and sex, performed all analyses
Yes
Does female sex compared with male sex result in greater coronary atheroma regression and plaque compositional changes after intensive lipid-lowering therapy in patients with established coronary artery disease?
Answers are grounded in this paper and cite their sources.
Women with coronary artery disease experience nearly fivefold greater coronary atheroma regression than men following intensive lipid-lowering therapy—especially when achieving LDL-C <55 mg/dL—underscoring the need for aggressive, target-driven lipid management to overcome sex disparities in secondary prevention.
BACKGROUND: Intensive 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. OBJECTIVES: The 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. METHODS: Data 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. RESULTS: ), and higher fibrous content (mean: 41.5% vs 36.7%). Following treatment achieving similar low-density lipoprotein-cholesterol (LDL-C) (∼70 mg/dL), women showed greater regression in PAV (least-squares-mean: -0.25% vs -0.05%) and TAV, with similar plaque stabilization. Female sex independently predicted PAV regression, which was most pronounced in women achieving LDL-C <55 mg/dL. CONCLUSIONS: 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.
No takes yet. Share an insight, caveat, or question.
Bansal et al. (2026) conducted a meta-analysis in Angiographically confirmed coronary artery disease (n=2,737). Female sex (among patients treated with intensive lipid-lowering therapy) vs. Male sex (among patients treated with intensive lipid-lowering therapy) was evaluated on Annualized change in percent atheroma volume (PAV) from baseline to follow-up (β -0.24, 95% CI -0.38 to -0.10, p=0.005). Female sex was associated with significantly greater coronary percent atheroma volume regression than male sex after intensive lipid-lowering therapy (-0.25% vs -0.05%, P = 0.005).
Synapse has enriched 10 related papers. Consider them for comparative context: