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

Abstract

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

Response to Comment on Stegman et al. High-Intensity Statin Therapy Alters the Natural History of Diabetic Coronary Atherosclerosis: Insights From SATURN. Diabetes Care 2014;37:3114–3120

“…Huang and Chen (1) in our article (2). We agree that the diabetic population is heterogeneous in terms of cardiovascular risk, with varying comorbidities and duration and severity of diabetes per se.…”

Impact of Diabetic Status on Outcomes After Revascularization With Drug-Eluting Stents in Relation to Coronary Artery Disease Complexity

“…4 In addition, advances in medical therapy including high-dose statins seem to mitigate the markedly accelerated progression of native atherosclerosis in diabetic patients. 5 Intriguingly, although diabetes mellitus has historically been considered a powerful Background-Diabetes mellitus and angiographic coronary artery disease complexity are intertwined and unfavorably affect prognosis after percutaneous coronary interventions, but their relative impact on long-term outcomes after percutaneous coronary intervention with drug-eluting stents remains controversial. This study determined drug-eluting stents outcomes in relation to diabetic status and coronary artery disease complexity as assessed by the Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score.…”

Refined Nine-Lead Total QRS Voltage With Body Mass Index Might Offer a Better Diagnostic Accuracy!

“…2,3 Finally, between 2 matched groups analysis, Cortese et al registered a significant acute kidney injury reduction (primary end point) in transradial group (8.4% vs 16.9%, p ¼ 0.007) and Thrombolysis In Myocardial Infarction major bleedings (0.3% vs 3%, p ¼ 0.03; secondary end point) although no statistical difference emerged among common major adverse cardiac events and stent thrombosis. Therefore, it cannot be excluded an adjunctive role of bivalirudin to transradial primary percutaneous coronary intervention in lowering incidence of acute kidney injury through in-hospital reduction of overall major hemorrhagic events.…”

“…There has been significant evidence from previous studies validating the use of total 12-lead QRS voltage in diagnosing LVH, 2 especially in patients with systemic hypertension. 3 The investigators referenced a few studies that reported the total 12-lead QRS voltage as a superior criterion compared with the traditional criteria with cardiac weight at necropsy as a reference. 4 They also point out that this criterion showed a greater performance in obese patients compared with the normal-weight patients where resultant overall performance in predicting LVH was low.…”