title: Antiatherosclerotic effects of long-term maximally intensive statin therapy after acute coronary syndrome: insights from Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin.
abstract: OBJECTIVE
  Patients with acute coronary syndromes (ACS) display diffuse coronary atheroma instability and heightened risk of early and late recurrent coronary events. We compared the long-term antiatherosclerotic efficacy of high-intensity statins in patients with ACS when compared with stable disease.
  
  
  RESULTS
  Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) used serial intravascular ultrasound measures of coronary atheroma volume in patients treated with rosuvastatin 40 mg or atorvastatin 80 mg for 24 months. The overall effect of high-intensity statins on the change in coronary percent atheroma volume and major adverse cardiovascular events (death/nonfatal myocardial infarction/coronary revascularization) were evaluated in this post hoc analysis. When compared with non-ACS patients (n=678), patients with ACS (n=361) were younger, actively smoking, and have had a previous myocardial infarction (all P<0.001). At baseline, patients with ACS exhibited lower high-density lipoprotein cholesterol (43.5±11 versus 45.8±11 mg/dL; P=0.002), a higher apolipoprotein B: apolipoprotein A-1 ratio (0.90±0.24 versus 0.83±0.24; P<0.001) and greater percent atheroma volume (37.3±8.5% versus 35.9±8.1%; P=0.01) when compared with non-ACS patients. Despite similar achieved levels of lipid and inflammatory markers after high-intensity statin therapy, patients with ACS demonstrated greater percent atheroma volume regression than non-ACS patients (-1.46±0.14 versus -0.89±0.13; P=0.003). After propensity-weighted multivariable adjustment, baseline percent atheroma volume (P<0.001) and an ACS clinical presentation (P=0.02) independently associated with plaque regression. The 24-month major adverse cardiovascular events-free survival was similar between patients with ACS and non-ACS (90.6 versus 92.9%; P=0.25).
  
  
  CONCLUSIONS
  Long-term high-intensity statin therapy caused greater plaque regression and comparable major adverse cardiovascular events rates in ACS when compared with non-ACS patients. Despite a higher clinical risk profile, patients with ACS harbor a more modifiable disease substrate and seem to benefit the most from potent statin therapy.
authors.affiliation: From the Department of Cardiovascular Medicine (R.P., S.E.N.) C5Research (R.P., S.E.N., M.S., S.J.N.), Cleveland Clinic, OH; Section of Cardiovascular Research, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia (P.J.B.); INSERM Dyslipidaemia and Atherosclerosis Research Unit, Pitié-Salpetriere University Hospital, Paris, France (M.J.C.); West German Heart Center, Essen, Germany (R.E.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.L.); AstraZeneca, Wilmington, DE (J.S.R.); and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia (K.U., Y.K., S.J.N.).
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.affiliation: From the Department of Cardiovascular Medicine (R.P., S.E.N.) C5Research (R.P., S.E.N., M.S., S.J.N.), Cleveland Clinic, OH; Section of Cardiovascular Research, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia (P.J.B.); INSERM Dyslipidaemia and Atherosclerosis Research Unit, Pitié-Salpetriere University Hospital, Paris, France (M.J.C.); West German Heart Center, Essen, Germany (R.E.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.L.); AstraZeneca, Wilmington, DE (J.S.R.); and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia (K.U., Y.K., S.J.N.).
authors.forename: Steven E
authors.initials: SE
authors.lastname: Nissen
authors.affiliation: From the Department of Cardiovascular Medicine (R.P., S.E.N.) C5Research (R.P., S.E.N., M.S., S.J.N.), Cleveland Clinic, OH; Section of Cardiovascular Research, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia (P.J.B.); INSERM Dyslipidaemia and Atherosclerosis Research Unit, Pitié-Salpetriere University Hospital, Paris, France (M.J.C.); West German Heart Center, Essen, Germany (R.E.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.L.); AstraZeneca, Wilmington, DE (J.S.R.); and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia (K.U., Y.K., S.J.N.).
authors.forename: Mingyuan
authors.initials: M
authors.lastname: Shao
authors.affiliation: From the Department of Cardiovascular Medicine (R.P., S.E.N.) C5Research (R.P., S.E.N., M.S., S.J.N.), Cleveland Clinic, OH; Section of Cardiovascular Research, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia (P.J.B.); INSERM Dyslipidaemia and Atherosclerosis Research Unit, Pitié-Salpetriere University Hospital, Paris, France (M.J.C.); West German Heart Center, Essen, Germany (R.E.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.L.); AstraZeneca, Wilmington, DE (J.S.R.); and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia (K.U., Y.K., S.J.N.).
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: From the Department of Cardiovascular Medicine (R.P., S.E.N.) C5Research (R.P., S.E.N., M.S., S.J.N.), Cleveland Clinic, OH; Section of Cardiovascular Research, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia (P.J.B.); INSERM Dyslipidaemia and Atherosclerosis Research Unit, Pitié-Salpetriere University Hospital, Paris, France (M.J.C.); West German Heart Center, Essen, Germany (R.E.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.L.); AstraZeneca, Wilmington, DE (J.S.R.); and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia (K.U., Y.K., S.J.N.).
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Barter
authors.affiliation: From the Department of Cardiovascular Medicine (R.P., S.E.N.) C5Research (R.P., S.E.N., M.S., S.J.N.), Cleveland Clinic, OH; Section of Cardiovascular Research, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia (P.J.B.); INSERM Dyslipidaemia and Atherosclerosis Research Unit, Pitié-Salpetriere University Hospital, Paris, France (M.J.C.); West German Heart Center, Essen, Germany (R.E.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.L.); AstraZeneca, Wilmington, DE (J.S.R.); and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia (K.U., Y.K., S.J.N.).
authors.forename: M John
authors.initials: MJ
authors.lastname: Chapman
authors.affiliation: From the Department of Cardiovascular Medicine (R.P., S.E.N.) C5Research (R.P., S.E.N., M.S., S.J.N.), Cleveland Clinic, OH; Section of Cardiovascular Research, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia (P.J.B.); INSERM Dyslipidaemia and Atherosclerosis Research Unit, Pitié-Salpetriere University Hospital, Paris, France (M.J.C.); West German Heart Center, Essen, Germany (R.E.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.L.); AstraZeneca, Wilmington, DE (J.S.R.); and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia (K.U., Y.K., S.J.N.).
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.affiliation: From the Department of Cardiovascular Medicine (R.P., S.E.N.) C5Research (R.P., S.E.N., M.S., S.J.N.), Cleveland Clinic, OH; Section of Cardiovascular Research, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia (P.J.B.); INSERM Dyslipidaemia and Atherosclerosis Research Unit, Pitié-Salpetriere University Hospital, Paris, France (M.J.C.); West German Heart Center, Essen, Germany (R.E.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.L.); AstraZeneca, Wilmington, DE (J.S.R.); and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia (K.U., Y.K., S.J.N.).
authors.forename: Peter
authors.initials: P
authors.lastname: Libby
authors.affiliation: From the Department of Cardiovascular Medicine (R.P., S.E.N.) C5Research (R.P., S.E.N., M.S., S.J.N.), Cleveland Clinic, OH; Section of Cardiovascular Research, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia (P.J.B.); INSERM Dyslipidaemia and Atherosclerosis Research Unit, Pitié-Salpetriere University Hospital, Paris, France (M.J.C.); West German Heart Center, Essen, Germany (R.E.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.L.); AstraZeneca, Wilmington, DE (J.S.R.); and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia (K.U., Y.K., S.J.N.).
authors.forename: Joel S
authors.initials: JS
authors.lastname: Raichlen
authors.affiliation: From the Department of Cardiovascular Medicine (R.P., S.E.N.) C5Research (R.P., S.E.N., M.S., S.J.N.), Cleveland Clinic, OH; Section of Cardiovascular Research, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia (P.J.B.); INSERM Dyslipidaemia and Atherosclerosis Research Unit, Pitié-Salpetriere University Hospital, Paris, France (M.J.C.); West German Heart Center, Essen, Germany (R.E.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.L.); AstraZeneca, Wilmington, DE (J.S.R.); and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia (K.U., Y.K., S.J.N.).
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Uno
authors.affiliation: From the Department of Cardiovascular Medicine (R.P., S.E.N.) C5Research (R.P., S.E.N., M.S., S.J.N.), Cleveland Clinic, OH; Section of Cardiovascular Research, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia (P.J.B.); INSERM Dyslipidaemia and Atherosclerosis Research Unit, Pitié-Salpetriere University Hospital, Paris, France (M.J.C.); West German Heart Center, Essen, Germany (R.E.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.L.); AstraZeneca, Wilmington, DE (J.S.R.); and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia (K.U., Y.K., S.J.N.).
authors.forename: Yu
authors.initials: Y
authors.lastname: Kataoka
authors.affiliation: From the Department of Cardiovascular Medicine (R.P., S.E.N.) C5Research (R.P., S.E.N., M.S., S.J.N.), Cleveland Clinic, OH; Section of Cardiovascular Research, Baylor College of Medicine, and the Methodist DeBakey Heart and Vascular Center, Houston, TX (C.M.B.); Centre for Vascular Research, University of New South Wales, Sydney, New South Wales, Australia (P.J.B.); INSERM Dyslipidaemia and Atherosclerosis Research Unit, Pitié-Salpetriere University Hospital, Paris, France (M.J.C.); West German Heart Center, Essen, Germany (R.E.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.L.); AstraZeneca, Wilmington, DE (J.S.R.); and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia (K.U., Y.K., S.J.N.). stephen.nicholls@sahmri.com.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D001054:Apolipoproteins A / Q000097:blood; D001055:Apolipoproteins B / Q000097:blood; D000069059:Atorvastatin; D008076:Cholesterol, HDL / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005464:Fluorobenzenes / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011743:Pyrimidines / Q000627:therapeutic use*; D011758:Pyrroles / Q000627:therapeutic use*; D012307:Risk Factors; D000068718:Rosuvastatin Calcium; D013449:Sulfonamides / Q000627:therapeutic use*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000924:Anticholesteremic Agents; D001054:Apolipoproteins A; D001055:Apolipoproteins B; D008076:Cholesterol, HDL; D005464:Fluorobenzenes; D006538:Heptanoic Acids; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D000069059:Atorvastatin
keywords: acute coronary syndrome; atherosclerosis; statins, HMG-CoA