Intensive statin therapy reverses plaque buildup

Using intravascular ultrasound, researchers have found that intensive cholesterol lowering with a statin drug can regress the buildup of plaque in the coronary arteries, according to a study presented at the annual meeting of the American College of Cardiology in Atlanta.

Lead author Dr. Steven Nissen, a cardiologist at the Cleveland Clinic, said that previous similar studies had shown slowing of coronary disease but not regression. But Johns Hopkins University researchers in 2004 documented plaque regression in patients on statins using transesophageal MR imaging (Circulation 2004;110[16]:2336-2341).

The specific statin regimen in the Cleveland Clinic study significantly lowered bad cholesterol and markedly increased good cholesterol levels, according to Nissen. The mean baseline LDL cholesterol of 130.4 mg/dL dropped to 60.8 mg/dL in the study patients, a reduction of 53.2%. This is the largest reduction in cholesterol ever observed in a major statin outcome trial.

The mean HDL cholesterol (43.1 mg/dL at baseline) increased to 49.0 mg/dL, a 14.7% increase, which was also unprecedented. The arterial plaque overall was reduced by 6.8% to 9.1% for the various measures of disease burden.

This study was known by the acronym ASTEROID (A Study To Evaluate the Effect of Rosuvastatin On Intravascular Ultrasound-Derived Coronary Atheroma Burden Trial).

The trial was conducted at 53 community and tertiary-care centers in the U.S., Canada, Europe, and Australia. A total of 507 patients had baseline IVUS exams and received 40 mg daily of rosuvastatin (Crestor).

Atherosclerosis progression was assessed at baseline and after at 24 months of treatment.

For more information from the Diagnostic Imaging archives:

Optical coherence tomography characterizes arterial plaque

Coronary artery calcium score predicts future cardiac events

CT leads imaging field in plaque assessment

Transesophageal MRI shows early plaque reduction