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.
Nissen S, For the REVERSAL Investigators. Aggressive Lipid-Lowering Therapy and Regression of Coronary Atheroma—Reply. JAMA. 2004;292(1):38. doi:10.1001/jama.292.1.39-c