Statins have revolutionized the treatment of cardiovascular disease and have repeatedly demonstrated their ability to reduce adverse cardiovascular outcomes.  However despite tantalizing data from some trials suggesting statins may even be capable of causing disease regression, few studies have formally assessed the comparative ability of competing drugs to achieve this.

The SATURN study enrolled 1039 patients with known coronary disease and performed serial intravascular ultrasound assessments at baseline and after 104 weeks of treatment with either atorvastatin 80 mg daily, or rosuvastatin 40 mg daily.  At study end the rosuvastatin group had lower levels of LDL cholesterol (1.62 vs. 1.82 mmol/l, P<0.001), and higher HDL (1.30 vs. 1.26 mmol/l, P=0.01).  Despite this, rosuvastatin was no better than atorvastatin in inducing plaque regression, with the primary efficacy end point, percent atheroma volume (PAV), decreasing by 0.99% with atorvastatin and by 1.22% with rosuvastatin (P=0.17).  Both agents induced regression in the majority of patients: 63.2% with atorvastatin and 68.5% with rosuvastatin and both had acceptable side-effect profiles, with a low incidence of laboratory abnormalities and cardiovascular events.

Conclusions

High dose rosuvastatin and atorvastatin both resulted in significant but similar degrees of regression of coronary atherosclerosis, despite the achievement of a more favorable lipid profile with rosuvastatin.

• Nicholls SJ, Ballantyne CM, Barter PJ et al.  Effect of Two Intensive Statin Regimens on Progression of Coronary Disease. N Engl J Med. 2011 Nov 15. [Epub ahead of print]