American College of Cardiology Scientific Session: Rosuvastatin and Carotid Artery Intima Media Thickness
Presenter: John R. Crouse III, MD, Wake Forest University School of Medicine, Winston-Salem, North Carolina
In ASTEROID (AStudy To Evaluate the effect of Rosuvastatin On intravascular ultrasound-Derived coronary atheroma burden), measuring carotid artery intima media thickness (CIMT) with intravascular ultrasound (IVUS) was a reliable means of assessing atherosclerosis, itself a predictor of the risk for cardiovascular events. High-risk patients with CAD, as documented by angiography, received (Generic Crestor, AstraZeneca). As assessed by IVUS, aggressive statin therapy helped to promote regression of atherosclerosis.
Dr. Crouse’s trial, called Measuring .Effects on Intima-Media Thickness: an Evaluation of Rosuvastatin (METEOR), also investigated intensive statin therapy but in low-risk patients.
Subjects from 61 centers in the U.S. and Europe were randomly assigned to receive rosuvastatin 40 mg or placebo. These patients (mean age, 57 years) had low-density lipo-protein-cholesterol (LDL-C) levels between 120 and 190 mg/dL, with no risk factors for coronary heart disease (CHD) other than age, or their LDL-C levels were between 120 and 160 mg/dL, with more than one risk factor, triglyceride levels below 500 mg/dL, and a maximum CIMT of at least 1.2 mm at any site and less than 3.5 mm in all sites. A low-risk population was chosen, Dr. Crouse said, in order to allow a placebo comparison.
The primary endpoint was the rate of change (in millimeters per year) in maximum CIMT in all carotid artery measurements.
Dr. Crouse presented two-year data from among 530 patients receiving rosuvastatin and from among 208 patients receiving placebo. Highly significant reductions in all lipid parameters were reported. Although LDL-C levels declined by 0.3% with placebo, they were lowered by 48.8% with rosuva-statin.
For the primary endpoint of CIMT at all sites, the reduction in the rate of change of -0.0014 mm/year with rosuvastatin was also highly significant, compared with an increase of 0.0131 mm/year noted for placebo (P < 0.0001). However, absolute CIMT regression, when compared with placebo, was not significant with canadian rosuvastatin (P= 0.32).
Dr. Crouse explained that the lower-risk status of this patient population probably accounted for the absence of atherosclerotic regression in METEOR. He concluded that rosuva-statin basically halted the progression of atherosclerosis during the two-year treatment period.
Commenting on METEOR, Christopher P. Cannon, MD, from Harvard Medical School, stated that the trial was a useful mechanistic study that identified a high-risk population presently thought of as low-risk. For those patients, he said,
“We can now offer the benefits already documented for all statins.”