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16-11-2011 | Cardiology | Article

Maximal statin doses lead to coronary plaque regression

Abstract

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MedWire News: A head-to-head comparison of maximal-dose atorvastatin and rosuvastatin has shown that both result in marked regression of coronary atherosclerosis in patients with heart disease.

The extent of plaque reversal was "unprecedented," while both treatments were well-tolerated, the study authors say.

"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 lead investigator Stephen Nicholls (Cleveland Clinic, Ohio, USA), who presented the results at the American Heart Association Annual Scientific Sessions, in Orlando, Florida. "It's a very positive outcome for patients and shows the benefits of high doses of statins."

The randomized, double-blind Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) included 1039 patients with coronary heart disease who underwent ultrasound assessment of coronary atherosclerotic plaques at baseline and after 2 years of treatment with either atorvastatin 80 mg/day or rosuvastatin 40 mg/day.

The researchers found that low-density lipoprotein (LDL) cholesterol reduced to 62.6 mg/dL (1.62 mmol/L) in the rosuvastatin group compared with 70.2 mg/dL (1.82 mmol/L) in the atorvastatin group at study completion. High-density lipoprotein (HDL) cholesterol increased to 50.4 mg/dL (1.30 mmol/L) compared with 48.6 mg/dL (1.26 mmol/L) in the rosuvastatin and atorvastatin groups, respectively. Both these between-group differences were statistically significant.

Although rosuvastatin treatment resulted in lower levels of LDL cholesterol and higher levels of HDL cholesterol than atorvastatin therapy, the primary endpoint of percent decrease in atheroma volume (PAV) did not differ significantly between the two groups, at 1.22% versus 0.99%, respectively.

However, the secondary endpoint of reduction in total atheroma volume (TAV) was more favorable with rosuvastatin, at 6.93 mm3 versus 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 2 years.

Despite both drugs being given at their highest recommended doses, side effects were minimal and both statins were well tolerated.

Discussant for the trial at the conference, Darwin Labarthe (Northwestern University, Chicago, Illinois, USA), cautioned that the results were inconclusive regarding the main study question, however.

He noted that the experience of 346 (25%) of the patients who withdrew from the study or did not have evaluable final ultrasound results, "could change the findings significantly."

He concluded: "The finding that nearly one-third of patients continue to experience progression supports the need to develop additional anti-atherosclerotic therapies."

By MedWire Reporters

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