The Pharmaceutical Journal
Vol 276 No 7392 p309
18 March 2006

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Atherosclerosis reversed by intensive statin therapy

In the first study to show regression of atherosclerosis with lipid lowering, two years' treatment with 40mg rosuvastatin (Crestor) achieved reduction in plaque volume in coronary arteries (published online in JAMA on 13 March).

The ASTEROID (a study to evaluate the effect of rosuvastatin on intravascular ultrasound-derived coronary atheroma burden) trial included 507 patients requiring coronary angiography who were found to have at least one major narrowing in a coronary vessel. Intravascular ultrasound (IVUS) imaging was used to measure atherosclerotic plaques in a coronary vessel at baseline and after 24 months of treatment with rosuvastatin. The study was open-label but those reviewing the IVUS images were blinded as to whether the images had been taken at baseline or after treatment.

Results showed a 0.79 per cent median reduction in percent atheroma volume in the entire target vessel after two years’ treatment (P<0.001), with a 6.8 per cent reduction in total atheroma volume (P<0.001). LDL-cholesterol was reduced by 53 per cent from baseline, from a mean of 3.4 to 1.6mmol/L, and HDL-cholesterol increased by 15 per cent, from 1.1 to 1.3mmol/L.

Reporting the findings at the American College of Cardiology Congress in Atlanta , Georgia, this week, lead investigator, Steven Nissen, Cleveland Clinic Foundation, Cleveland, Ohio, said: “Treatment to LDL-cholesterol levels below currently accepted guidelines, when accompanied by significant HDL-cholesterol increases, can regress atherosclerosis in coronary disease patients.” Professor Nissen added that further studies were needed to determine the effect of the observed changes on clinical outcome.

Duncan McRobbie, CHD Adviser for London Pharmacy Services, for London, Eastern and the South East, said: “These are interesting early data. It will be interesting to see hard endpoints, including mortality, as seen in other statin trials.” He added: “High-dose statins, as a class, are not without side effects. We need to carefully weigh up benefits against possible risks.”

The study reported that 40mg rosuvastatin was well tolerated; the number of patients with an increase in liver enzymes was 1.8 per cent, which was similar to that seen in other statin trials and there were no cases of rhabdomyolysis.