Content area
Full text
Several large prospective clinical trials have established the benefit of low-density lipoprotein (LDL) cholesterol reduction with 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) in the primary and secondary prevention of cardiovascular events [1-4]. These observations have recently been extended by reports that intensive lowering of LDL-cholesterol to levels lower than those recommended by previous guidelines is associated with an incremental clinical benefit [5-7]. LDL-cholesterol plays a pivotal role in the progression of atherosclerotic coronary artery disease (CAD) [8,9]. Early studies employing quantitative coronary angiography (QCA) demonstrated that statin therapy can reduce the rate of progression of angiographic coronary disease [10,11]. However, none of these studies reported that statin therapy alone resulted in regression of angiographic disease. Angiography only provides a silhouette of the vessel lumen and does not directly visualize the entire extent of atheroma within the arterial wall. This represents a potential limitation in the use of serial QCA to accurately assess changes in atheroma burden in response to medical therapies.
Intravascular ultrasound (IVUS) provides high-resolution tomographic images of the entire arterial wall and, as a result, visualizes the full extent of atheroma within the coronary arteries rather than the presence of luminal stenoses. Using coronary ultrasonic imaging, it has previously been reported that intensive lipid lowering can halt the progression of coronary atheroma [12]. However, there has been no clinical trial evidence of coronary atheroma regression in statin- treated patients. Studies with rosuvastatin have demonstrated greater lowering of LDL-cholesterol and greater elevation of high-density lipoprotein (HDL) cholesterol than previously reported with other statins [13]. The objective of A Study To Evaluate the effect of Rosuvastatin On Intravascular ultrasound-Derived coronary atheroma burden (ASTEROID) was to investigate whether the combination of very intensive lowering of LDL-cholesterol and raising of HDL-cholesterol would promote coronary atherosclerotic regression monitored by serial IVUS. ASTEROID demonstrated statistically significant regression of atherosclerosis after 24 months of treatment with rosuvastatin 40 mg in patients with angiographically documented CAD [14].
Study design
ASTEROID was a multicenter, prospective, open-label, blinded end point trial of a maximal dosage of rosuvastatin in patients with established CAD, defined as the presence of at least one stenosis greater than 20% by coronary angiography performed for a clinical indication. An arterial segment of at least 40 mm, containing no stenosis...