High-intensity statin treatment is associated with reduced plaque structural stress and remodelling of artery geometry and plaque architecture.

Gu, Sophie Z; Costopoulos, Charis; Huang, Yuan; Bourantas, Christos; Woolf, Adam; Sun, Chang; Teng, Zhongzhao; Losdat, Sylvain; Räber, Lorenz; Samady, Habib; Bennett, Martin R (2021). High-intensity statin treatment is associated with reduced plaque structural stress and remodelling of artery geometry and plaque architecture. European heart journal open, 1(3), oeab039. Oxford University Press 10.1093/ehjopen/oeab039

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Plaque structural stress (PSS) is a major cause of atherosclerotic plaque rupture and major adverse cardiovascular events (MACE). We examined the predictors of changes in peak and mean PSS (ΔPSSpeak, ΔPSSmean) in three studies of patients receiving either standard medical or high-intensity statin (HIS) treatment.

Methods and results

We examined changes in PSS, plaque size, and composition between 7348 co-registered baseline and follow-up virtual-histology intravascular ultrasound images in patients receiving standard medical treatment (controls, n = 18) or HIS (atorvastatin 80 mg, n = 20, or rosuvastatin 40 mg, n = 22). The relationship between changes in PSSpeak and plaque burden (PB) differed significantly between HIS and control groups (P < 0.001). Notably, PSSpeak increased significantly in control lesions with PB >60% (P = 0.04), but not with HIS treatment. However, ΔPSSpeak correlated poorly with changes in lumen and plaque area or PB, plaque composition, or lipid lowering. In contrast, ΔPSSpeak correlated significantly with changes in lumen curvature, irregularity, and roughness (P < 0.05), all of which were reduced in HIS patients. ΔPSSmean correlated with changes in lumen area, PA, PB, and circumferential calcification, and was unchanged with either treatment.


Our observational study shows that PSSpeak changes over time were associated with baseline disease severity and treatment. The PSSpeak increase seen in advanced lesions with standard treatment was associated with remodelling artery geometry and plaque architecture, but this was not seen after HIS treatment. Smoothing plaques by reducing plaque/lumen roughness, irregularity, and curvature represents a novel mechanism whereby HIS may reduce PSS and, thus may protect against plaque rupture and MACE.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)

UniBE Contributor:

Losdat, Sylvain Pierre, Räber, Lorenz


600 Technology > 610 Medicine & health




Oxford University Press




Pubmed Import

Date Deposited:

05 Aug 2022 10:00

Last Modified:

20 Feb 2024 14:16

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Atherosclerosis Plaque architecture Plaque structural stress Virtual-histology intravascular ultrasound





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