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High-Dose Rosuvastatin (Crestor) Shrinks Coronary Plaque in Heart Attack Patients

Study is first to use ultrasound imaging inside coronary arteries

One year of treatment with the highest dose of the cholesterol-lowering drug rosuvastatin can shrink plaque in the arteries of patients with ST segment elevation myocardial infarction (STEMI), according to a new study presented September 2 at the European Society of Cardiology (ESC) Congress in Barcelona, Spain.

Although STEMI patients undergo revascularization procedures to open the “culprit” artery that caused their heart attack, they remain at increased risk for similar events because of plaque formation in untreated coronary arteries.

The IBIS-4 study, which was published in the European Heart Journal, was the first to use ultrasound imaging inside coronary arteries both at the time of a heart attack and after 13 months of treatment to show the beneficial effect of high-dose statin therapy on plaque burden, said lead investigator Lorenz Räber, MD.

The study included 103 patients with an acute heart attack who were successfully treated to open the culprit vessel. The subjects then underwent imaging at the start of the study and again after 13 months of high-dose rosuvastatin treatment to assess the drug’s impact on their non-culprit arteries.

Rosuvastatin was administered at a dosage of 40 mg daily. After 13 months, ultrasonography showed that 85% of the patients had regression of plaque in at least one artery, and that 56% had regression in both. Overall, the intracoronary plaque volume was reduced by a mean of –0.9% (P = 0.007), with a mean change in the total atheroma volume of –13.7 mm3 (P = 0.006). Although the reduction in plaque volume was independent of cholesterol levels at baseline, it was directly related to the extent of cholesterol reduction at 13 months.

An analysis of the composition of plaque tissue using radiofrequency intravascular ultrasonography showed no changes in high-risk tissue (the necrotic core) and no reduction in high-risk plaques.

As expected, rosuvastatin had beneficial effects on cholesterol levels. Low-density lipoprotein cholesterol (LDL-C), or “bad” cholesterol, decreased from a median of 3.29 mmol/L at baseline to 1.89 mmol/L (P < 0.001), corresponding to a 43% reduction. A guideline-recommended LDL level of less than 1.8 mmol/L was achieved by 44% of the patients.

High-dose rosuvastatin (40 mg) is not approved in many European countries. An initial dose of 10 to 20 mg is usually used.

In the U.S., rosuvastatin (Crestor, AstraZeneca) is approved at a dose range of 5 to 40 mg once daily. The current product labeling recommends that the 40-mg dose should be used only for patients not reaching their LDL-C goal with 20 mg.

Sources: ESC; September 2, 2014; and Crestor Prescribing Information; July 2014.

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