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Rodriguez-Granillo et al. 1 report arterial remodelling data from the ‘PERSPECTIVE’ study,2 an imaging substudy of the ‘EUROPA’ study.3 ‘EUROPA’ is a randomized, placebo-controlled, multicentre trial, which demonstrated that the angiotensin-converting enzyme (ACE) inhibitor perindopril reduced adverse clinical events in 12 218 patients with stable coronary artery disease (CAD). The EUROPA investigators suggested that the clinical benefit is related to anti-atherosclerotic effects of ACE inhibitors. However, the ‘PERSPECTIVE’ substudy, which examined the impact of perindopril on atherosclerosis in a subset of 118 patients, found neither an effect on plaque burden assessed by intravascular ultrasound (IVUS) nor an effect on angiographic luminal diameter. The lack of change in these imaging end-points could indicate that the clinical benefit of ACE inhibition is not mediated by changes of atherosclerotic plaque anatomy. However, an alternative explanation is that ACE inhibition exerts other plaque-stabilizing effects including modification of plaque composition and arterial remodelling.This hypothesis is examined in the current, serial IVUS study, which investigates the effect of perindopril on arterial remodelling and plaque composition. Remodelling was defined as a relative increase (expansive remodelling) or decrease (constrictive remodelling) of the mean vessel cross-sectional area (CSA) between baseline and follow-up. A total of 711 matched 5 mm segments from 118 IVUS examinations were available at baseline and after 3-year follow-up. There was no significant difference in the change of plaque burden between the perindopril and placebo groups. However, the … *Corresponding author. Tel: +1-216-445-7579. E-mail address: schoenp1{at}ccf.org

european heart journal

Arterial remodelling: an independent pathophysiological component of atherosclerotic disease progression and regression. Insights from serial pharmacological intervention trials