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Rosuvastatin yields regression in coronary atherosclerosis

Wednesday, April 02 2008 | Comments

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What's This? By Nancy Stanley

Rosuvastatin lowers LDL cholesterol, increases HDL cholesterol, and produces regression by decreasing percent diameter stenosis and improving minimum lumen diameter (MLD) as measured by quantitative coronary angiography in statin-naive patients with coronary artery disease, according to new evidence.

For the prospective, open-label ASTEROID trial, 507 patients with coronary artery disease received rosuvastatin 40 mg/day for 24 months. Of these patients, 292 had baseline and follow-up angiography and had >=1 segments with >25% stenosis at baseline.

The protocol prespecified analysis was to determine if treatment with rosuvastatin 40 mg reduced the percent diameter stenosis in segments with >25% stenosis at baseline, as measured by quantitative coronary angiography.

Rosuvastatin significantly reduced total cholesterol by 33.9% (from 204.7 mg/dL at baseline to 133.9 mg/dL at study end), LDL cholesterol by 53.3% (from 131.5 mg/dL to 61.1 mg/dL), non-HDL cholesterol by 47% (from 161.9 mg/dL to 85.6 mg/dL), the LDL/HDL cholesterol ratio by 58.2% (from 3.24 to 1.33), and triglycerides by 12.3% (from 151.8 mg/dL to 123.5 mg/dL; P<.001 for all). Rosuvastatin also significantly increased HDL cholesterol by 13.8% (from 42.8 mg/dL to 48.3 mg/dL; P<.001).

Additionally, the median change in percent diameter stenosis decreased from 35.7% at baseline to 34.5% at the end of the study, while the median MLD increased from 1.62 mm to 1.67 mm (P<.001 for both).

Stenosis was reduced in 53.4% of the patients, whereas 40.8% had increased stenosis and 5.8% had no change. Further, 7.5% of the patients had stenosis reduced by >=10%, 89.4% had stenosis changed by <10%, and 3.1% had stenosis increased by >=10%. The percentage of patients who had regression in stenosis was significantly greater than the percentage of patients who had progression in stenosis (P<.03).

"Perhaps most importantly, 97% of the patients were either stable or had regression of atherosclerosis," said Dr. Christie Ballantyne, lead researcher.

In regard to MLD, 55.2% of the patients had a larger MLD, 4.3% had no change, and 40.6% had a smaller MLD. In addition, 12.1% of the patients had an MLD larger by >=0.2 mm, 81.9% had a change of <0.2 mm, and 6.0% had an MLD smaller by >=0.2 mm.

"Therefore, 94% were either stable or had regression of their lesions," Dr. Ballantyne noted.

Again, the percentage of patients who had regression in MLD was significantly greater than the percentage of patients who had progression in MLD (P<.02).

"The relative importance of LDL cholesterol reduction and HDL cholesterol elevation with statin therapy in producing these results on atherosclerosis in both intravascular ultrasound and quantitative coronary angiography trials will require further investigation," Dr. Ballantyne said. (Presentation 407-4.)

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