Effect of Two Intensive Statin Regimens on Progression of Coronary Disease

Nicholls, Stephen J.; Ballantyne, Christie M.; Barter, Philip J.; Chapman, M. John; Erbel, Raimund; Libby, Peter; Raichlen, Joel S.; Uno, Kiyoko; Borgman, Marilyn; Wolski, Kathy; Nissen, Steven E.

doi:10.1097/01.sa.0000414260.89578.71

Cited by 88 publications

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“…More recent studies have demonstrated that statins are similarly beneficial for the primary and secondary prevention of CVD [10,20,24] and that the relative risk reduction is similar even in patients with very low absolute CV risk [22]. These results are partially explained by intra-vascular ultrasound (IVUS) studies showing that intensive LDL-C lowering using statins can significantly slow, and even reverse, the progression of atherosclerotic plaques in people with coronary heart disease (CHD) [25,26]. Consequently, statins remain the first-line lipid-lowering strategy for the vast majority of people with CV risk, including those with T2D.…”

Section: Statins Are Safe and Effective For The Reduction Of CV Risk mentioning

confidence: 99%

The use of statins in people at risk of developing diabetes mellitus: Evidence and guidance for clinical practice

Sattar¹,

Ginsberg

Ray

et al. 2014

Atherosclerosis Supplements

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Reducing low-density lipoprotein cholesterol (LDL-C) levels using statins is associated with significant reductions in cardiovascular (CV) events in a wide range of patient populations. Although statins are generally considered to be safe, recent studies suggest they are associated with an increased risk of developing Type 2 diabetes (T2D). This led the US Food and Drug Administration (FDA) to change their labelling requirements for statins to include a warning about the possibility of increased blood sugar and HbA1c levels and the European Medicines Agency (EMA) to issue guidance on a small increased risk of T2D with the statin class. This review examines the evidence leading to these claims and provides practical guidance for primary care physicians on the use of statins in people with or at risk of developing T2D. Overall, evidence suggests that the benefits of statins for the reduction of CV risk far outweigh the risk of developing T2D, especially in individuals with higher CV risk. To reduce the risk of developing T2D, physicians should assess all patients for T2D risk prior to starting statin therapy, educate patients about their risks, and encourage risk-reduction through lifestyle changes. Whether some statins are more diabetogenic than others requires further study. Statin-treated patients at high risk of developing T2D should regularly be monitored for changes in blood glucose or HbA1c levels, and the risk of conversion from pre-diabetes to T2D should be reduced by intensifying lifestyle changes. Should a patient develop T2D during statin treatment, physicians should continue with statin therapy and manage T2D in accordance with relevant national guidelines.

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Section: Statins Are Safe and Effective For The Reduction Of CV Risk mentioning

confidence: 99%

The use of statins in people at risk of developing diabetes mellitus: Evidence and guidance for clinical practice

Sattar¹,

Ginsberg

Ray

et al. 2014

Atherosclerosis Supplements

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“…no. NCT000620542) directly compared the effect of two highintensity statin regimens (atorvastatin 80 mg vs. rosuvastatin 40 mg) on coronary atherosclerosis progression using serial intravascular ultrasound (IVUS) over 24 months (11). No appreciable difference of the primary efficacy end point of change in percent atheroma volume (PAV), safety, or clinical event rates was found between the two treatment groups.…”

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confidence: 99%

“…Aggressive LDL cholesterol (LDL-C) lowering with high-intensity statin therapy can regress coronary atheroma and reduce the incidence of cardiovascular events in patients with established CAD (10)(11)(12)(13). Although the clinical benefits of high-intensity statins have not yet undergone prospective evaluation in patients with diabetes, meta-analyses suggest that reductions in cardiovascular event rates parallel the degree of LDL-C lowering (14).…”

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High-Intensity Statin Therapy Alters the Natural History of Diabetic Coronary Atherosclerosis: Insights From SATURN

et al. 2014

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OBJECTIVEAlthough statins can induce coronary atheroma regression, this benefit has yet to be demonstrated in diabetic individuals. We tested the hypothesis that highintensity statin therapy may promote coronary atheroma regression in patients with diabetes. RESEARCH DESIGN AND METHODSThe 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. This analysis compared changes in biochemistry and coronary percent atheroma volume (PAV) in patients with (n = 159) and without (n = 880) diabetes. RESULTSAt baseline, patients with diabetes had lower LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) levels but higher triglyceride and CRP levels compared with patients without diabetes. At follow-up, diabetic patients had lower levels of LDL-C (61.0 6 20.5 vs. 66.4 6 22.9 mg/dL, P = 0.01) and HDL-C (46.3 6 10.6 vs. 49.9 6 12.0 mg/dL, P < 0.001) but higher levels of triglycerides (127.6 [98.8, 163.0] vs. 113.0 mg/dL [87.6, 151.9], P = 0.001) and CRP (1.4 [0.7, 3.3] vs. 1.0 [0.5, 2.1] mg/L, P = 0.001). Both patients with and without diabetes demonstrated regression of coronary atheroma as measured by change in PAV (20.83 6 0.13 vs. 21.15 6 0.13%, P = 0.08). PAV regression was less in diabetic compared with nondiabetic patients when on-treatment LDL-C levels were >70 mg/dL (20.31 6 0.23 vs. 21.01 6 0.21%, P = 0.03) but similar when LDL-C levels were £70 mg/dL (21.09 6 0.16 vs. 21.24 6 0.16%, P = 0.50). CONCLUSIONS

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“…En dos intervenciones conductuales, una aplicada con un apoyo en persona y la otra aplicada a distancia, sin contacto personal entre participantes y orientadores de la reducción de peso, los pacientes obesos alcanzaron y mantuvieron una reducción de peso clínicamente significativa a lo largo de un periodo de 24 meses. SATURN: comparación de la progresión de la aterosclerosis coronaria con dos pautas de estatinas de alta eficacia con efectos diferentes en las HDL 23 Presentado por: Stephen J. Nicholls, Cleveland, Ohio, Estados Unidos.…”

Section: Presentado Por: William E Boden Buffalo Nueva York Estadunclassified

Resumen de los ensayos clínicos presentados en las Sesiones Científicas Anuales de la American Heart Association (Orlando, Estados Unidos, 12-16 de noviembre de 2011)

Avanzas¹,

Bayés‐Genís²,

Isla³

et al. 2012

Revista Española de Cardiología

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(P. Avanzas).Full English text available from: www.revespcardiol.org 0300-8932/$ -see front matter © 2011 Sociedad Española de Cardiología. Publicado por Elsevier España, SL. Todos los derechos reservados. Historia del artículo:On-line el 12 de diciembre de 2011 En consonancia con su política de difusión de la información científica a la comunidad cardiológica 1-9 , REVISTA ESPAÑOLA DE CARDIOLOGÍA presenta una selección de los estudios más relevantes presentados en las Sesiones Científicas Anuales de la American Heart Association (Orlando, Estados Unidos, 12-16 de noviembre de 2011) y, en concreto, las denominadas sesiones «Late-Breaking Clinical Trials».De cada estudio destacado, se muestra un resumen en el que se reseñan brevemente sus objetivos, métodos y resultados, de acuerdo con lo allí expuesto en forma oral o, en su caso, publicado simultáneamente en revistas científicas en formato electrónico. Dado que la mayoría de ellos no se han publicado todavía en su versión final, la información que ofrecemos debe interpretarse como preliminar. SUMARIO POR TEMAS Síndromes coronarios agudosISAR-REACT 4: abciximab más heparina no fraccionada frente a bivalirudina en pacientes con infarto de miocardio sin elevación del ST a los que se practica una intervención coronaria percutánea (IPC). TRACER: ensayo de un antagonista del receptor de trombina para la reducción de los eventos clínicos en el síndrome coronario agudo.ATLAS ACS 2-TIMI 51: tratamiento anti-Xa para reducir los eventos cardiovasculares añadido al tratamiento estándar en pacientes con síndrome coronario agudo. Cardiología intervencionistaAIDA-STEMI: administración de abciximab en bolo intracoronario en comparación con bolo intravenoso durante la ICP.Formulario de consentimiento informado basado en la evidencia: puesta a prueba de un formulario de consentimiento informado individualizado basado en la evidencia para mejorar las experiencias de los pacientes con la ICP.CPORT E: Resultados de la ICP no primaria en hospitales con o sin disponibilidad de cirugía cardiaca en el propio centro: un estudio aleatorizado.Arritmias ALPHEE: estudio de determinación de dosis, controlado con placebo y a doble ciego, de la eficacia y la seguridad de la celivarona 50, 100 o 300 mg una vez al día, con el empleo de amiodarona como calibrador para la prevención de las activaciones de desfibrilador automático implantable o la muerte.FAST: ablación con catéter frente a la ablación quirúrgica de la fibrilación auricular: un ensayo clínico multicéntrico y aleatorizado.MANTRA-PAF: comparación multicéntrica y aleatorizada de la ablación por radiofrecuencia y el tratamiento farmacológico antiarrít-mico como terapia de primera línea en 294 pacientes con fibrilación auricular paroxística.PALLAS: resultados del estudio PALLAS. COPPS Atrial Fibrillation: la colchicina reduce la fibrilación auricular postoperatoria. PrevenciónAIM-HIGH: la niacina de liberación prolongada no reduce los eventos clínicos en pacientes con enfermedad cardiovascular establecida en los que se obtiene un contr...

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Effect of Two Intensive Statin Regimens on Progression of Coronary Disease

Cited by 88 publications

References 0 publications

The use of statins in people at risk of developing diabetes mellitus: Evidence and guidance for clinical practice

The use of statins in people at risk of developing diabetes mellitus: Evidence and guidance for clinical practice

High-Intensity Statin Therapy Alters the Natural History of Diabetic Coronary Atherosclerosis: Insights From SATURN

Resumen de los ensayos clínicos presentados en las Sesiones Científicas Anuales de la American Heart Association (Orlando, Estados Unidos, 12-16 de noviembre de 2011)

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