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July 7, 2004

Aggressive Lipid-Lowering Therapy and Regression of Coronary Atheroma—Reply

JAMA. 2004;292(1):38. doi:10.1001/jama.292.1.39-c

In Reply: Drs Ravnskov and Sutter suggest that we should have examined lumen area rather than atheroma volume. We disagree. Most myocardial infarctions occur at sites without flow-limiting lesions.1 Atherosclerosis is a disease of the vessel wall not the lumen. Remodeling preserves lumen size throughout much of the course of coronary disease.2 We used intravascular ultrasound because it enables precise quantification of coronary plaque in vivo. While we concur with Ravnskov and Sutter that nonlipid (eg, anti-inflammatory) effects may partially explain the superior outcome observed in patients who received atorvastatin, we think the evidence also strongly supports the benefits of greater lowering of LDL cholesterol. We plan to perform additional multivariate analyses to explore the contributions of lipid and nonlipid effects.