Statins reverse atherosclerosis

American College of Cardiology lipid targets, pregnancy and CVD, and dual antiplatelet therapy.

Aggressive treatment of high-risk patients to bring their lipid levels below the toughest UK targets could actually reverse atherosclerosis.

Data presented this week at the American College of Cardiology's annual conference in Atlanta, Georgia, show that reducing the LDL levels of coronary artery disease patients to 1.6mmol/l over two years can significantly reduce their coronary atherosclerosis.

The international ASTEROID (A Study to Evaluate the Effect of Rosuvastatin on Intravascular Ultrasound-Derived Coronary Atheroma Burden) study is the first to show convincingly regression in the pathology thought to lie behind most MI.

Previous trials have shown that aggressive treatment, reducing LDL levels to 2.0mmol/l, effectively halts the progression of atheroma.

The study included 349 patients treated with 40mg/day of rosuvastatin over 24 months, reducing their LDL by 53 per cent from a median of 3.3mmol/l to a median of 1.6mmol/l.

Based on intravascular ultrasound measurements taken before and after treatment, this produced a 9.1 per cent reduction in the volume of coronary atherosclerosis.

There was a reduction of atheroma in nearly two thirds of the patients, and 78 per cent had reduced atheroma in the most diseased parts of their coronary artery.

UK investigator Dr Neal Uren, consultant cardiologist at the Royal Infirmary Edinburgh said: 'This trial challenges the idea that it is enough to get a patient on to a statin and achieve LDL levels of 4 or 3.

'Patients at risk of coronary artery disease need to be on therapy that gets their LDL down to under 2, and preferably below 1.6mmol/l.'

Berkshire GP Dr George Kassianos, who has a special interest in cardiovascular disease, said: 'This study supports the idea that rather than the quality framework goal of total cholesterol of 5mmol/l, an LDL of 2 or less should be our target. We need to get as low as we can.'

But he added that 40mg was a rarely used dose, requiring a gradual increase in dose and monitoring of liver function.

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