High-dose atorvastatin, rosuvastatin regress plaque to similar degree
MedWire News: A head-to-head comparison of the highest doses of atorvastatin and rosuvastatin in the Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) showed that the two treatments resulted in significant but similar regression of coronary atherosclerosis.
SATURN included 1039 patients with coronary heart disease who underwent serial intravascular ultrasonography (IVUS) at baseline and after 104 weeks of treatment with either atorvastatin 80 mg/day or rosuvastatin 40 mg/day.
Although rosuvastatin treatment resulted in lower levels of low-density lipoprotein (LDL) cholesterol and higher levels of high-density lipoprotein (HDL) cholesterol than atorvastatin therapy, the primary endpoint of percent atheroma volume (PAV) did not differ significantly between the two groups at study completion. However, the secondary endpoint of normalized total atheroma volume (TAV) was more favorable with rosuvastatin.
"Regression of plaque has long been the holy grail of heart disease treatment, and in this trial more than two-thirds of the patients had regression," commented study investigator Stephen Nicholls (Cleveland Clinic, OH, USA) who presented the results. "It's a very positive outcome for patients and shows the benefits of high doses of statins."
The researchers found that LDL cholesterol reduced to 62.6 mg/dL (1.62 mmol/L) in the rosuvastatin group and 70.2 mg/dL (1.82 mmol/L) in the atorvastatin group at 104 weeks. HDL increased to 50.4 mg/dL (1.30 mmol/L) and 48.6 mg/dL (1.26 mmol/L) in the rosuvastatin and atorvastatin groups, respectively, over the same period. Both these between-group differences were statistically significant.
Reductions in PAV were similar with each treatment, at 1.22% in the rosuvastatin and 0.99% in the atorvastatin group, whereas the reduction in TAV was significantly greater with rosuvastatin, at 6.39 mm3 compared with 4.42 mm3 with atorvastatin.
Overall, 68.5% and 71.3% of patients taking rosuvastatin and 63.2% and 64.7% of those taking atorvastatin experienced PAV and TAV regression, respectively, over the 104 weeks.
Despite both drugs being given at their highest recommended doses, side effects were minimal and both statins were well tolerated.
"I believe we must find the findings of the study to be inconclusive regarding the study question," cautioned the discussant, Darwin Labarthe (Northwestern University, Chicago, Illnois, USA).
First, there is no significant difference in the primary outcome among the evaluated patients, and second, the results of the secondary outcome are inconsistent with this finding, he explained.
Finally, he drew attention to the fact that 346 patients (25%) withdrew from the study or did not have an evaluable final IVUS scan. "The experience of these patients who could not be evaluated could change the findings significantly," he said.
Nicholls commented that the "extent and frequency of regression observed in the SATURN trial is unprecedented."
However, he concluded: "The finding that nearly one-third of patients continue to experience progression supports the need to develop additional anti-atherosclerotic therapies."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Helen Albert