Rosuvastatin does not lead to regression of atherosclerosis
Patients receiving rosuvastatin (Crestor) experience reduced progression of carotid atherosclerosis compared with those taking placebo, but not a regression of disease, a recent study shows (JAMA 2007;297:1344).
The study, funded by AstraZeneca (maker of rosuvastatin), looked at whether
the statin could slow the progression, or cause regression, of atherosclerosis,
as measured by carotid intima-media thickness (CIMT) — an independent
predictor of cardiovascular events.
Researchers in the US and Europe randomised 984 middle-age, low-risk
patients to receive 40mg of rosuvastatin daily or placebo for two years.
They found that the change in maximum CIMT (for 12 carotid artery sites;
primary outcome measure) was less in the
rosuvastatin group than the placebo group (difference –0.0145mm/year,
95 per cent confidence interval –0.0196 to –0.0093; P<0.001).
Regression of CIMT was not significant within the rosuvastatin group.
The study does not address whether treatment with rosuvastatin improves
clinical outcomes or mortality. In an accompanying editorial (ibid, p1376)
Michael Lauer from the Cleveland Clinic Lerner College of Medicine, Ohio,
discusses the appropriateness of measuring surrogate endpoints, such
as CIMT, for primary prevention trials. He says: “The evidence
is not yet sufficient to comfortably conclude that a reduction in progression
of atherosclerosis by carotid imaging in low-risk individuals will necessarily
translate into a reduction in clinical events.” Low-risk individuals
should not routinely undergo arterial imaging followed by statin therapy
on discovery of asymptomatic disease, he suggests.
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