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Few head-to-head trials have focused on how well intensive statin regimens achieve regression of coronary atherosclerosis. Now, investigators have used serial intravascular ultrasound (IVUS) to track changes in plaque volume in a randomized comparison of rosuvastatin (40 mg daily) and atorvastatin (80 mg daily) involving 1039 patients with coronary disease. Rosuvastatin's manufacturer funded the study.
After 2 years of treatment, mean levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol in the rosuvastatin group (62.6 and 50.4 mg/dL, respectively) were significantly lower than in the atorvastatin group (70.2 and 48.6 mg/dL). Mean percent atheroma volume (PAV) decreased by almost exactly 1% with atorvastatin and slightly more than 1% with rosuvastatin — significant changes from baseline but a nonsignificant difference between the groups. Atherosclerosis regression, defined by reduction in PAV, was documented in 63.2% of the atorvastatin group and 68.5% of the rosuvastatin group, another nonsignificant difference. The two drugs' side-effect profiles were similar. Laboratory abnormalities and adverse cardiovascular events were uncommon, although the trial was not powered to assess events.
Nicholls SJ et al. Effect of two intensive statin regimens on progression of coronary disease. N Engl J Med 2011 Nov 15; [e-pub ahead of print]. (http://www.nejm.org/doi/full/10.1056/NEJMoa1110874)
Comment
Both of the two most intensive statin regimens available safely yielded significant atherosclerosis regression, as measured by changes in percent atheroma volume over 2 years. This regression was more profound than that documented in prior intravascular ultrasound studies and was achieved at low-density lipoprotein cholesterol levels substantially lower than those recommended by clinical guidelines, although the degree of the regression did not correlate with the degree of LDL reduction. Whether lower atheroma volumes result in better clinical outcomes is also unclear; until more data are available, we have no reason to favor one of these regimens over the other.