Coronary atherosclerosis can regress with very intensive statin therapy.
The ASTEROID trial (JAMA 2006; 295:1556-1565) showed that very intensive statin therapy with rosuvastatin 40 mg once daily results in highly significant regression of coronary atherosclerosis as assessed by serial intravascular ultrasonography (IVUS). The mean low-density lipoprotein cholesterol (LDL-C) level achieved with this regimen was 61 mg/dL, and the mean high-density lipoprotein cholesterol (HDL-C) level increased by 15%. While the merits of concomitant LDL-C-lowering and HDL-C-raising therapies remain to be determined, the results of the ASTEROID and other recent trials suggest that the optimal strategy for lipid-lowering in patients with coronary artery disease is to try for the lowest LDL-C level that can be attained without adverse effects.
Sipahi
Ilke
I
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH 44195, USA. sipahii@ccf.org
Nicholls
Stephen J
SJ
Tuzcu
E Murat
EM
Nissen
Steven E
SE
D008078:Cholesterol, LDL / Q000097:blood; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D005464:Fluorobenzenes / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D011743:Pyrimidines / Q000008:administration & dosage*; D000068718:Rosuvastatin Calcium; D013449:Sulfonamides / Q000008:administration & dosage*; D018084:Ultrasonography, Interventional
D008078:Cholesterol, LDL; D005464:Fluorobenzenes; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium