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

Rishi Puri, Steven E. Nissen, Mingyuan Shao, Christie M. Ballantyne, Philip J. Barter, M. John Chapman, Raimund Erbel, Peter Libby, Joel S. Raichlen, Kiyoko Uno, Yu Kataoka, Stephen J. Nicholls

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Objectives-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.

Approach and 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.

LanguageEnglish
Pages2465-2472
Number of pages8
JournalArteriosclerosis, thrombosis, and vascular biology
Volume34
Issue number11
DOIs
Publication statusPublished - 1 Nov 2014

Keywords

  • Acute coronary syndrome
  • Atherosclerosis
  • Statins, HMG-CoA

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Puri, Rishi ; Nissen, Steven E. ; Shao, Mingyuan ; Ballantyne, Christie M. ; Barter, Philip J. ; Chapman, M. John ; Erbel, Raimund ; Libby, Peter ; Raichlen, Joel S. ; Uno, Kiyoko ; Kataoka, Yu ; Nicholls, Stephen J. / 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. In: Arteriosclerosis, thrombosis, and vascular biology. 2014 ; Vol. 34, No. 11. pp. 2465-2472.
@article{f2d367282f3a48c9a24ad5cc0d6ad5e4,
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 = "Objectives-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.Approach and 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.",
keywords = "Acute coronary syndrome, Atherosclerosis, Statins, HMG-CoA",
author = "Rishi Puri and Nissen, {Steven E.} and Mingyuan Shao and Ballantyne, {Christie M.} and Barter, {Philip J.} and Chapman, {M. John} and Raimund Erbel and Peter Libby and Raichlen, {Joel S.} and Kiyoko Uno and Yu Kataoka and Nicholls, {Stephen J.}",
year = "2014",
month = "11",
day = "1",
doi = "10.1161/ATVBAHA.114.303932",
language = "English",
volume = "34",
pages = "2465--2472",
journal = "Arteriosclerosis, thrombosis, and vascular biology",
issn = "1079-5642",
publisher = "Lippincott Williams and Wilkins",
number = "11",

}

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. / Puri, Rishi; Nissen, Steven E.; Shao, Mingyuan; Ballantyne, Christie M.; Barter, Philip J.; Chapman, M. John; Erbel, Raimund; Libby, Peter; Raichlen, Joel S.; Uno, Kiyoko; Kataoka, Yu; Nicholls, Stephen J.

In: Arteriosclerosis, thrombosis, and vascular biology, Vol. 34, No. 11, 01.11.2014, p. 2465-2472.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Antiatherosclerotic effects of long-term maximally intensive statin therapy after acute coronary syndrome

T2 - Arteriosclerosis, thrombosis, and vascular biology

AU - Puri, Rishi

AU - Nissen, Steven E.

AU - Shao, Mingyuan

AU - Ballantyne, Christie M.

AU - Barter, Philip J.

AU - Chapman, M. John

AU - Erbel, Raimund

AU - Libby, Peter

AU - Raichlen, Joel S.

AU - Uno, Kiyoko

AU - Kataoka, Yu

AU - Nicholls, Stephen J.

PY - 2014/11/1

Y1 - 2014/11/1

N2 - Objectives-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.Approach and 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.

AB - Objectives-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.Approach and 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.

KW - Acute coronary syndrome

KW - Atherosclerosis

KW - Statins, HMG-CoA

UR - http://www.scopus.com/inward/record.url?scp=84911932109&partnerID=8YFLogxK

U2 - 10.1161/ATVBAHA.114.303932

DO - 10.1161/ATVBAHA.114.303932

M3 - Article

VL - 34

SP - 2465

EP - 2472

JO - Arteriosclerosis, thrombosis, and vascular biology

JF - Arteriosclerosis, thrombosis, and vascular biology

SN - 1079-5642

IS - 11

ER -