High-intensity statin therapy alters the natural history of diabetic coronary atherosclerosis: Insights from SATURN

Brian Stegman, Rishi Puri, Leslie Cho, Mingyuan Shao, Christie M. Ballantyne, Phillip J. Barter, M. John Chapman, Raimund Erbel, Peter Libby, Joel S. Raichlen, Kiyoko Uno, Yu Kataoka, Steven E. Nissen, Stephen J. Nicholls

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Abstract

OBJECTIVE: Although 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 METHODS: The 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. RESULTS: At 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 ± 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). Both patients with and without diabetes demonstrated regression of coronary atheroma as measured by change in PAV (-0.83 ± 0.13 vs. -1.15 ± 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 (-0.31 ± 0.23 vs. -1.01 ± 0.21%, P = 0.03) but similar when LDL-C levels were ≤ 70 mg/dL (-1.09 ± 0.16 vs. -1.24 ± 0.16%, P = 0.50). CONCLUSIONS: High-intensity statin therapy alters the progressive nature of diabetic coronary atherosclerosis, yielding regression of disease in diabetic and nondiabetic patients.

Original languageEnglish
Pages (from-to)3114-3120
Number of pages7
JournalDiabetes Care
Volume37
Issue number11
DOIs
Publication statusPublished - 1 Nov 2014
Externally publishedYes

Cite this

Stegman, B., Puri, R., Cho, L., Shao, M., Ballantyne, C. M., Barter, P. J., Chapman, M. J., Erbel, R., Libby, P., Raichlen, J. S., Uno, K., Kataoka, Y., Nissen, S. E., & Nicholls, S. J. (2014). High-intensity statin therapy alters the natural history of diabetic coronary atherosclerosis: Insights from SATURN. Diabetes Care, 37(11), 3114-3120. https://doi.org/10.2337/dc14-1121