Study: Two Statin Drugs both Reverse Plaques

A buildup of plaques in the arteries leads to cardiovascular disease, which continues to be a leading cause of death in the U.S. Two of the most common drugs used to help reverse this buildup are Lipitor and Crestor. Results of a recent research study show that both of them are effective in reversing the buildup—but there are some concerns. Let's review the results.

The SATURN Research Study

The results of the SATURN (Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin versus Atorvastatin) trial were published in the December 1, 2011 issue of the New England Journal of Medicine.

Patients with plaques in their coronary arteries were randomly assigned to take either atorvastatin (Lipitor at 80 mg daily) or rosuvastatin (Crestor at 40 mg daily). These are the highest FDA approved doses of these two medications, which are the most potent of the statins. The research study included 1039 patients; the extent of plaques in their arteries was determined by using a special intravascular type of sonogram (IVUS) done at the beginning of the study and again after 104 months of treatment.

Interestingly, rosuvastatin lowered the average LDL cholesterol significantly more than atorvastatin (63 vs. 70 mg/dL). It also increased HDL cholesterol, or "good" cholesterol, significantly more (50.4 vs. 48.6 mg/dL). However, both drugs were equally effective in causing a reversal of plaques buildup. Such a reversal, or regression, was seen in about two-thirds of the patients in the study. The study was too small to tell whether one treatment was more effective than the other in preventing cardiovascular events. Adverse effects were uncommon.

Significance of the Results

The results of this study provide further evidence for the benefits of improving levels of LDL and HDL cholesterol.
Nonetheless, the findings are not entirely positive. The fact that atheromas, or lipid-containing plaques, progressed in fully one-third of the patients shows the need to do more than just improve the levels of blood fats in the blood. In addition, regression of plaques in no way assures that the number of heart attacks will decline in these patients. That's because the small plaques, rather than the larger ones, are more likely to rupture. And these ruptures can lead to a clot that causes a heart attack by completely blocking blood flow to heart muscle.

What we really need to know is whether the positive regression effects of these drugs is also accompanied by changes in the composition and structure of the plaque. If this were the case it would be helpful because ruptures would also be less likely. Doctors have their work cut out for them on this matter in order to figure out how to prevent the development of even small plaques.