Potent Statins Reverse Plaque Build-Up

Aggressive and intensive statin treatments seem to be able to reverse the build-up of plaque in arteries, according to a new study.

Researchers at the Cleveland Clinic (OH, USA), Baylor College of Medicine (Houston, TX, USA), and other institutions performed serial intravascular ultrasonography in 1,039 patients with coronary disease, both at baseline and after 104 weeks of treatment with either atorvastatin (80 mg daily), or rosuvastatin (40 mg daily), to compare the effect of the two intensive statin regimens on the progression of coronary atherosclerosis, as well as to assess their safety and side-effect profiles. The primary efficacy end point was percent atheroma volume (PAV), and the secondary efficacy end point was normalized total atheroma volume (TAV).

The results showed that after 104 weeks of therapy, the rosuvastatin group had lower levels of LDL cholesterol than the atorvastatin group, and higher levels of high-density lipoprotein (HDL) cholesterol. The primary efficacy end point, PAV, decreased by 0.99% with atorvastatin and by 1.22% with rosuvastatin; the secondary efficacy end point, TAV, was more favorable with rosuvastatin than with atorvastatin: -6.39 mm³, as compared with -4.42 mm³. Both agents induced regression in the majority of patients; 63.2% with atorvastatin and 68.5% with rosuvastatin for PAV, and 64.7% and 71.3%, respectively, for TAV. Both agents had acceptable side-effect profiles, with a low incidence of laboratory abnormalities and cardiovascular events.

“Despite the lower level of LDL cholesterol and the higher level of HDL cholesterol achieved with rosuvastatin, a similar degree of regression of PAV was observed in the two treatment groups,” concluded lead author Stephen Nicholls, MD, PhD, of the Cleveland Clinic, and colleagues. “Doctors have been reluctant to use high doses of statins, but in this study the drugs were safe, well tolerated, and had a profound impact on lipid levels, the amount of plaque in vessel walls, and the number of cardiovascular events.”

Statins lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver. Randomized controlled trials have shown that they are most effective in those with cardiovascular disease (CVD), with questionable benefit in those without previous CVD but with elevated cholesterol levels. Statins have rare but severe adverse effects, particularly muscle damage, and some doctors believe they are overprescribed. Atorvastatin, marketed as Lipitor and manufactured by Pfizer (New York, NY, USA), is the best-selling pharmaceutical in history, with reported sales of USD 12.4 billion in 2008.

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Cleveland Clinic
Baylor College of Medicine
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