Koo wrote: "Bear in a nut shell,...what is this all about, ...if you please?" and "Bear is any of this information ( abstracts presented in Austrlia and Spain) presenting any new findings with regards to...  "attenuated coronary atherosclerotic plaque"... from what we already know post-2013 ASSURE, other than RVX-208 is now being referred to as Apabetalone."

The ESC abstract isn't available as of right now (meeting abstracts still embargoed?), but below is the text of the abstract from the Australia meeting that Imtesty posted. Both abstracts refer to "attenuated coronary atherosclerotic plaque." The key here is that "attenuated plaque" is a measure of vulnerable atherosclerotic plaque and is not the same as the IVUS-derived percent atheroma volume (PAV) or total atheroma volume (TAV) measures that we saw come out of ASSURE and earlier ASSURE post-hoc. So this is not simply a re-hash of the 2013 data but a new post-hoc focused on a unique kind of plaque picked up by IVUS.  

I have tried to find a good review of attenuated plaque but can't seem to find one. Here is a 2009 abstract on attenuated plaque. Attenuated plaque seems to be an unusual IVUS finding (hypoechoic or mixed atheroma plaque with deep ultrasound attenuation but without calcification) that is more common in patients with acute coronary syndrome and seems to be associated with a higher inflammatory status, more severe and complex lesion morphology, high rate of transient deterioration in coronary flow during percutaneous coronary intervention (PCI), no-reflow after PCI, and a larger infarct size. 

So this seems to be a new positive finding from ASSURE. I don't see why Resverlogix wouldn't want to highlight this....maybe that is in the plan with an ESC releated news release? What I can't tell from the abstract is if they are only looking within the apabetalone group (baseline vs. 6 months) or if they were also comparing against the placebo group. Cool stuff. If anyone finds a good article or review on attenuated plaque, please share.

The Relationship Between Lipoprotein Particle and Attenuated Coronary Atherosclerotic Plaques in Patients Treated with Apabetalone — Insights from ASSURE Trial

"Background: Apabetalone (RVX-208), the first selective bromodomain and extra-terminal (BET) inhibitor, modulates lipid and inflammatory pathways implicated in atherosclerosis. The impact of apabetalone on attenuated plaque (AP), a measure of vulnerability, is unknown.

Methods: The ApoA-1 Synthesis Stimulation and intravascular Ultrasound for coronary atheroma Regression Evaluation (ASSURE) study employed serial IVUS measures of coronary atheroma in 281 patients treated with RVX-208 or placebo for 26 weeks. Attenuated plaque (AP) was measured at baseline and follow-up. Factors associated with changes in AP were investigated.

Results: AP was observed in 31 (11%) patients. The apabetalone group demonstrated reductions in AP length by 1 mm (p = 0.03), AP arc by 37.0o (p = 0.004) and the AP index (API) by 34.6 mmo (p = 0.02). The change in API correlated with the on-treatment HDL particle concentration (r = -0.50, p = 0.007), but not HDL-C (r = -0.20, p = 0.36) or apoA-1 (r = -0.20, p = 0.25). Multivariable analysis revealed that on-treatment concentrations of HDL (p = 0.03) and VLDL (p = 0.01) particle concentrations independently associated changes in API.

Conclusions: Apabetalone may have a potential beneficial effect on ultrasonic measures of vulnerable atherosclerotic plaque, which may relate to its favourable effects on circulating HDL particle concentrations. The clinical implications are currently being investigated in large cardiovascular outcome trials."