An epic battle comparing the two most potent statins– the reigning king atorvastatin versus “gorilla statin” rosuvastatin– ended with a quiet draw. Results of SATURN (Study of CoronaryAtheroma by InTravascular Ultrasound: Effect of Rosuvastatin Versus AtorvastatiN) were presented at the AHA and published simultaneously in the New England Journal of Medicine.
Stephen Nicholls and colleagues randomized 1039 patients with coronary disease to rosuvastatin or atorvastatin for 2 years and measured the progression of atherosclerosis using intravascular ultrasound (IVUS). As anticipated, after 2 years lipid parameters were more favorable in the rosuvastatin than in the atorvastatin group:
- LDL: 62.6 mg/dl in the rosuvastatin group versus 70.2 mg/dl in the atorvastatin group (p=0.01)
- HDL: 50.4 versus 48.6 mg/dl (p=0.01)
However, there was no significant difference in the percent atheroma volume (PAV), the primary efficacy endpoint, which decreased by 0.99% with atorvastatin and 1.22% with rosuvastatin (p=0.17). A secondary endpoint, normalized total atheroma volume, significantly favored rosuvastatin (-6.39 mm(3) versus -4.42 mm(3), p=0.01). Regression of atherosclerosis, as measured by both PAV and TAV, occurred in a majority of patients in both treatment groups, a difference which the investigators terms “relatively modest.”
Although the trial failed to find a difference between the agents, “it does show that high-dose, intensive statin therapy can be administered safely and can promote regression of atherosclerotic plaque to a greater extent than has previously been reported,” the authors concluded.