Statins Induce Regression of Mild Coronary Atherosclerotic Plaques

April 05, 2012

By Will Boggs MD

NEW YORK (Reuters Health) Apr 02 - Usual doses of atorvastatin and, to a greater extent, rosuvastatin induce regression of mild coronary atherosclerotic plaques in statin-naive patients, researchers from Korea report.

"Plaque regression was observed in about 70% of patients, which is a little bit bigger in magnitude than in previous statin trials," Dr. Seung-Jung Park from University of Ulsan in Seoul told Reuters Health in an email.

However, Dr. Park noted, "Only statin-naive patients with mild coronary atherosclerotic plaques were included, who are more likely to regress in response to statin therapy."

In a study reported online March 20th in the American Journal of Cardiology, Dr. Park and colleagues used intravascular ultrasound (IVUS) to compare the effects of atorvastatin (10 to 20 mg/day) vs rosuvastatin (10 mg/day) on mild coronary atherosclerotic plaques. The trial, called ARTMAP, involved 350 patients, including 271 with evaluable baseline and follow-up IVUS.

The primary endpoint, percent change in total atheroma volume (TAV) at six months, was significantly greater with rosuvastatin (-7.4%) than with atorvastatin (-3.9%; p=0.018)

Plaque regression (any negative change in TAV) occurred in a larger proportion of the rosuvastatin group (78.1% vs 65.0%), but change in percent atheroma volume did not differ significantly between the treatment groups.

At six months, lipid measurements improved to a similar extent in both treatment groups.

"It is therefore tempting to speculate that rosuvastatin has a more significant effect on lesion 3-hydroxy-3-methylglutaryl-coenzyme A reductase compared to atorvastatin, leading to regression of coronary atherosclerotic plaques," the researchers note. "However, this hypothesis requires further confirmation."

"Advanced atherosclerotic plaques with heavy calcification may not be regressible despite statin therapy," Dr. Park said. "In terms of plaque regression, therefore, the early initiation of statin therapy may be better."

It remains unclear whether the differences in atorvastatin and rosuvastatin will translate into clinical superiority of rosuvastatin, and Dr. Park would not speculate about whether one statin should be favored over the other at this point.

"Plaque quality as well as plaque quantity is important in patients with coronary artery disease," Dr. Park explained. "Further studies using new imaging tools (for example, virtual histology IVUS, optical coherence tomography, etc.) may be needed to investigate plaque quality (vulnerability)."


Am J Cardiol 2012.


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