Graphical Abstract.

Plaques progress over time with standard medical treatment due to changes in plaque microstructure, resulting in increased peak PSS. High-intensity statins remodel the lumen/plaque interface, reducing lumen curvature, irregularity and roughness, and preventing the increase in peak PSS seen with standard medical treatment. Smoothing plaques and reducing lumen curvature represent novel mechanisms whereby high-intensity statins may protect against plaque rupture. PSS, plaque structural stress.