Slide Source: Lipids Online Slide Library Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) Nissen SE et al. JAMA 2004;291: patients with symptomatic CAD with angiographic stenosis >20% and LDL-C 125–210 mg/dL; 502 with evaluable follow-up Randomization to pravastatin 40 mg/d or atrovastatin 80 mg/d for 18 months IVUS performed at baseline and 18 months Primary endpoint: percent change in atheroma volume assessed with IVUS

Slide Source: Lipids Online Slide Library Baseline Characteristics: REVERSAL Pravastatin (n=249) Atorvastatin (n=253)p Age, y Male73%71%.69 White87%90%.54 Current smoker27%26%.97 Past or nonsmoker74%.97 Hx HTN70%68%.70 Prior statin use32%25%.06 Hx DM18%20%.65 LDL-C, mg/dL ± ± HDL-C, mg/dL 42.9 ± ± TG, mg/dL ± ± CRP, mg/L3.0 ± ± Nissen SE et al. JAMA 2004;291:

Slide Source: Lipids Online Slide Library PravastatinAtorvastatin REVERSAL: Primary and Secondary Endpoints— Change in Atheroma Volume Assessed by IVUS Change from Baseline, % p=.02 p=.02 p< – –0.9 Nissen SE et al. JAMA 2004;291: p< p=.01 p=.001 1° endpoint: Percent change in atheroma volume Total atheroma volume Change in percent atheroma volume p=.98p=.72 p=.18

Slide Source: Lipids Online Slide Library PravastatinAtorvastatin REVERSAL: Lipid and CRP Changes Change from Baseline, % –34.1 Nissen SE et al. JAMA 2004;291: p<.001 TCLDL-CHDL-CTG Apo B-100 CRP –18.4 –25.2 – –6.8 –20.0 –22.0 –39.1 –5.2 –36.4 p<.001p=.06p<.001

Slide Source: Lipids Online Slide Library Pravastatin 40 mg Atorvastatin 80 mg REVERSAL: Final Lipids on Treatment Mg/dL Nissen SE et al. JAMA 2004;291: LDL-C Apo B-100TGHDL-C

Slide Source: Lipids Online Slide Library REVERSAL: Effects on LDL-C Nissen SE et al. JAMA 2004;291: LDL-C was reduced to a mean of 110 mg/dL with pravastatin 40 mg and 79 mg/dL with atorvastatin 80 mg ATP III goal of LDL-C <100 mg/dL was achieved by 65% of pravastatin patients and 97% of atorvastatin patients