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ASTEROID The Effect of Very High-Intensity Statin Therapy on Regression of Coronary Atherosclerosis Pr Jacques PUEL C.H.U. de Rangueil, Toulouse Service.

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Présentation au sujet: "ASTEROID The Effect of Very High-Intensity Statin Therapy on Regression of Coronary Atherosclerosis Pr Jacques PUEL C.H.U. de Rangueil, Toulouse Service."— Transcription de la présentation:

1 ASTEROID The Effect of Very High-Intensity Statin Therapy on Regression of Coronary Atherosclerosis Pr Jacques PUEL C.H.U. de Rangueil, Toulouse Service de Cardiologie Vice-président de la SFC Investigateur français de létude ASTEROID Diapositives extraites de la présentation de S NISSEN - ACC 2006

2 Prior coronary IVUS progression trials Median change in atheroma volume (%) Mean LDL-C (mg/dL) REVERSAL pravastatin REVERSAL atorvastatin CAMELOT placebo A-Plus placebo ACTIVATE placebo Relationship between LDL-C and progression rate Unexplored region

3 1183 patients screened and 507 patients treated at 53 centers in US, Canada, Europe and Australia Rosuvastatin 40 mg for 24 months Follow-up IVUS of originally imaged target vessel (n=349) Intravascular ultrasound with 40 MHz transducer Motorized pullback at 0.5 mm/sec through >40 mm length of single target coronary artery 158 patients withdrew or did not have an evaluable final IVUS

4 Lumen area EEM area Atheroma area Ultrasound determination of atheroma area Precise planimetry of EEM and lumen borders with calculation of atheroma cross-sectional area

5 Lipid values and percent change (n=349) * Time-weighted average From least square mean

6 Dual primary IVUS efficacy parameters Median change in percent atheroma volume Median change in most diseased subsegment Regression p<0.001* *Wilcoxon signed rank test for comparison with baseline Regression p<0.001* Change in atheroma volume (mm 3 ) Change in atheroma volume (%)

7 Distribution: Percent atheroma volume Number of patients Regression 63.6% Progression 36.4% Change in percent atheroma volume (%)

8 Change in atheroma volume Subgroups: On-treatment lipid levels *p<0.001 for change from baseline (regression) LDL-C mean (n=192) LDL-C > mean (n=157) HDL-C mean (n=197) HDL-C > mean (n=152) Change in atheroma volume (%) LDL-C < 70 (n=254) LDL-C (n=78) LDL-C 100 (n=17) * * * * * p=NS for change from baseline

9 Adverse events: Safety population (n=507)

10 Conclusions I Very intensive treatment with rosuvastatin 40 mg in statin-naïve patients with CAD reduced LDL-C to 60.8 mg/dL and raised HDL-C by 14.7%. This regimen resulted in significant regression for all three primary and secondary IVUS efficacy parameters (p<0.001). Regression occurred in 64% to 78% of subjects treated, depending on the efficacy parameter. Regression was observed in subgroups including men and women, older and younger patients, and those with LDL-C above and below the mean.

11 Limitations ASTEROID explore des coronaires ath é romateuses mais ne consid è re pas les l é sions ath é roscl é reuses vuln é rables et instables ayant provoqu é ou é tant susceptible de provoquer un syndrome coronarien aigu. L é tude n aborde pas les r é sultats biologiques concernant les marqueurs d inflammation (CRP, cholest é rol LDL etc.).

12 Conclusions II The adverse events observed with this regimen were low and typical of other high-intensity statin trials. The relative importance of LDL-C reduction and HDL- C elevation in producing these results will require further investigation. Maximally intensive statin treatment seems warranted in high-risk CAD patients. Rather than a fixed LDL-C goal, these findings suggest attaining the lowest levels of LDL-C achievable without adverse effects may be the optimal strategy.

13 Prise en charge thérapeutique du patient à haut risque cardiovasculaire Recommandations. Afssaps, mars ** Diabète de type 2 à haut risque atteinte rénale, ou au moins deux des facteurs de risque suivants : âge, antécédents familiaux de maladie coronaire précoce, tabagisme,hypertension artérielle, HDL-cholestérol 30 mg/24 h) Patient à haut risque cardiovasculaire : - Antécédents de maladie cardiovasculaire avérée - Diabète de type 2 à haut risque** - Risque de survenue dun événement coronarien dans les 10 ans 20% Objectif thérapeutique LDL-cholestérol < 1,0 g/l

14 Recent coronary IVUS progression trials Median change in atheroma volume (%) Mean low-density lipoprotein cholesterol (mg/dL) REVERSAL pravastatin REVERSAL atorvastatin CAMELOT placebo A-Plus placebo ACTIVATE placebo Relationship between LDL-C and progression rate ASTEROID rosuvastatin r 2 = 0.95 p<0.001


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