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Diabetic Coronary Atherosclerosis Regression Seen with High-Intensity Statin Therapy

High-intensity statin therapy altered the progressive nature of coronary atheroma in diabetic and nondiabetic patients….

Statins can lead to the regression of coronary atheroma but this benefit had not previously been demonstrated in diabetic coronary atherosclerosis. Therefore, the Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) was conducted to test the hypothesis that high-intensity statin therapy may induce coronary atheroma regression in patients with diabetes.

Patients were treated with either rosuvastatin 40 mg or atorvastatin 80 mg for 24 months, and a serial intravascular ultrasound was used to measure their coronary atheroma volume. There were 159 patients that were diabetic and 880 patients that were nondiabetic, and the changes in their biochemistry and coronary percent atheroma volume (PAV) were compared in this analysis.

When compared with the nondiabetic patients, the diabetic patients had lower LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) levels but higher triglyceride and CRP levels at baseline. After 24-months, at follow-up, diabetic patients still had lower levels of LDL-C (61.0 ± 20.5 vs. 66.4 ± 22.9 mg/dL, p=0.01) and HDL-C (46.3 ± 10.6 vs. 49.9 ± 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). The regression of coronary atheroma was seen in both patient groups, where nondiabetic patients had a reduction in PAV of 1.15 ± 0.13% (p=0.08), while diabetic patients had a reduction in PAV of 0.83 ± 0.13%. When on-treatment LDL-C levels were >70 mg/dL, PAV regression was 1.01 ± 0.21% in nondiabetic patients and only 0.31 ± 0.23% in diabetic patients, but when LDL-C levels were ≤70 mg/dL, PAV regression was similar in both groups (−1.09 ± 0.16 vs. −1.24 ± 0.16%, P = 0.50).

The researchers concluded that high-intensity statin therapy promoted the regression of coronary atherosclerosis in both diabetic and nondiabetic patients.

Practice Pearls:
  • High-intensity statin therapy can induce the regression of coronary atheroma in patients with or without diabetes.
  • When LDL-C levels were >70 mg/dL, PAV regression was less in diabetic patients compared with nondiabetic patients.
  • However, when LDL-C levels were ≤70 mg/dL, PAV regression was similar in both groups.

Published online on Sep 4, 2014 in Diabetes Care.