Can high-dose statins reduce atherosclerosis?

The aim of this study was to characterize the factors associated with reduced coronary atherosclerosis for patients who receive high-dose statins.

Coronary atherosclerosis is the narrowing and hardening of the coronary arteries (the vessels that supply blood to the heart) due to accumulation of cholesterol (atheroma) inside the walls of the arteries. This leads to coronary artery disease (CAD) and cardiovascular events such as heart attacks, strokes or peripheral vascular disease. Previous studies showed that high dose statin drugs (cholesterol lowering drugs) such as atorvastatin (Lipitor) and rosuvastatin (Crestor) can stop the progression of atherosclerosis and sometimes produce disease regression for patients at high risk for future cardiovascular events. This article aimed to evaluate the factors associated with regression of coronary atherosclerosis in patients treated with high doses of statins.

This study included 1039 patients with CAD. All patients received high dose statins for 2 years: 519 patients received 80 mg of atorvastatin and 520 received 40 mg of rosuvastatin. Intravascular ultrasound (imaging of the inside of the heart and coronary arteries using sound waves) was performed at the beginning of the study and after 104 weeks of treatment to determine the changes in the total atheroma volume or TAV (defined as the size of the atheroma) and the per cent atheroma volume or PAV (defined as the size of the coronary artery tube occupied by the atheroma). Cholesterol and triglyceride (a type of fat in the body) blood levels were also measured.

Results show that patients who received rosuvastatin had a greater reduction in cholesterol levels, while the atorvastatin-treated group experienced greater reduction in triglyceride levels. Also, compared to atorvastatin, in the rosuvastatin group there was a greater reduction in TAV, but not in PAV. This reduction was mostly seen in patients with diabetes and high initial values for TAV, blood pressure, cholesterol and triglycerides. Greater reductions in PAV with rosuvastatin were seen in women and in patients with high initial cholesterol levels. 

In conclusion, both rosuvastatin and atorvastatin in high doses reduced coronary atherosclerosis after 2 years of treatment, with a greater reduction for rosuvastatin. Patients with more advanced disease (larger atheroma, high cholesterol and blood pressure, diabetes) were more likely to benefit from high dose statin therapy.

Ask your doctor about statin therapy.