Regression of atherosclerotic plaque is possible with adequate lipid-lowering therapy
Previously, with low-intensity statin therapy (pravastatin 40 mg), slowing down of progression of atherosclerosis had been demonstrated. Progression was, however, ongoing. Later, with higher intensity statin (atorvastatin 80 mg) reversal of the primary endpoint was seen as compared with treatment with pravastatin: instead of a continued increase in total atheroma volume from baseline, atorvastatin treatment showed no significant change from baseline. Thus; atherosclerotic progression was halted. The GLAGOV study, which evaluated the effect of treatment with the PCSK9 inhibitor evolocumab on progression of coronary disease in statin-treated patients, showed for the first time a reduction of percent atheroma volume and total atheroma volume with evolocumab, as compared with statin monotherapy. It should be noted that interindividual variation in response to treatment with regard to plaque burden is large. In GLAGOV, 64.3% of patients showed regression of plaque, and in the remainder of patients, atherosclerosis continued to progress despite treatment. See slide below.