A study presented at the American College of Cardiology's 55th Annual Scientific Session recently demonstrates, for the first time, that very intensive cholesterol lowering with a statin drug can regress (partially reverse) the buildup of plaque in the coronary arteries.
This finding has never before been observed in a study using statin drugs, the most commonly used cholesterol lowering treatment. Previous research had indicated that intensive statin therapy could prevent the progression of coronary atherosclerosis, or arterial plaque build-up, but not actually reduce disease burden. ACC.06 is the premier cardiovascular medical meeting, bringing together more than 30,000 cardiologists to further breakthroughs in cardiovascular medicine.
The intense statin therapy used in this study resulted in significant regression of atherosclerosis as measured by intravascular ultrasound (IVUS), a technique in which a tiny ultrasound probe is inserted into the coronary arteries to measure plaque. The study showed that regression occurred for all three pre-specified IVUS measures of disease burden. The mean baseline LDL cholesterol of 130.4 mg/dL dropped to 60.8 mg/dL in the study patients, an reduction of 53.2 percent. This is the largest reduction in cholesterol ever observed in a major statin outcome trial. Mean HDL cholesterol (43.1 mg/dL at baseline) increased to 49.0 mg/dL, a 14.7 percent 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 of ASTEROID (A Study To Evaluate the Effect of Rosuvastatin On Intravascular Ultrasound-Derived Coronary Atheroma Burden [ASTEROID] Trial). The trial was conducted at 53 community and tertiary care centers in the United States, Canada, Europe, and Australia. A total of 507 patients had baseline intravascular ultrasound (IVUS) examination and received 40 mg daily of rosuvastatin (brand name Crestor®). IVUS provides a precise and reproducible method for determining the change in plaque, or atheroma, burden during treatment. Atherosclerosis progression was assessed at baseline and after at 24 months of treatment.
"Previous similar studies with statins have shown slowing of coronary disease, but not regression. This regimen significantly lowered bad cholesterol, and surprisingly, markedly increased good cholesterol levels," said Steven Nissen, M.D., F.A.C.C., of the Cleveland Clinic and lead author of the study. Dr. Nissen is also President-Elect of the American college of Cardiology. "We conclude that very low LDL levels (below current guidelines), when accompanied by raised HDL, can regress, or partially reverse, the plaque buildup in the coronary arteries."
Dr. Nissen presented the results of the "Effect of Very Low LDL-C Levels on Regression of Coronary Atherosclerosis: Results of the ASTEROID Trial" study on Monday, March 13.
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