The evidence supporting the benefits of using statins to reduce cardiovascular events has been well documented, especially in the prevention of subsequent events in people who have suffered a heart attack (secondary prevention). But do different statin drugs differ in their ability to reduce plaque build-up and reduce LDL (bad) cholesterol levels? The SATURN trial examined this question by comparing the efficacy of rosuvastatin (Crestor) and atorvastatin (Lipitor) in reducing fatty deposits, or plaque build-up, in artery walls, as measured by percent atheroma volume (PAV).
For the study, just published in the New England Journal of Medicine, researchers from the Cleveland Clinic analyzed over 1,000 coronary heart disease patients who received intensive treatment with either 80 mg of atorvastatin or 40 mg of rosuvastatin, daily. After two years of follow-up, the results revealed that both statin therapies were equally effective at decreasing PAV, though rosuvastatin which is the most potent statin available decreased total volume of fatty plaque deposits significantly more than atorvastatin. In addition, patients on rosuvastatin achieved lower levels of LDL cholesterol and exhibited lower ratios of LDL cholesterol to HDL (good) cholesterol.
Though there was no significant difference between the two groups in the number of cardiovascular (CV) events, ACSH's Dr. Gilbert Ross points out that this was simply a biomarker study and thus cannot be used to measure differences in clinical outcomes. The researchers did not provide a control group, so we don t know how these drugs differ in preventing future cardiovascular events, he says. Though many previous studies have indicated that statins reduce the incidence of subsequent CV events in people who had already suffered a heart attack, Dr. Ross says that the evidence that these drugs confer primary prevention in people with no CV event history is not so strong, and this study will do nothing to illuminate that issue.
What really caught the attention of ACSH s Dr. Josh Bloom, however, was the very low risk profile associated with use of these drugs. There wasn t a single case of rhabdomyolysis a dangerous breakdown of muscle fibers and only a very small number of people experienced elevated liver enzymes, which is rather amazing, given the large number of people taking the drugs in such high doses.
Dr. Bloom also notes that the trial was commissioned by AstraZeneca, maker of Crestor, in hopes of demonstrating its superiority over Lipitor, since the Pfizer blockbuster drug will go generic in 2012. Bet AstraZeneca s not too happy about this study right now, he notes.
As Dr. Ross adds, If I had a patient who required a high-dose statin, I would be leaning toward prescribing them Crestor. However, because Lipitor will soon be available at a significantly lower cost, Dr. Ross admits that his preference for Crestor would not justify its much higher price tag.