JACC in a Flash | SATURN: Women See Greater Atheroma Regression with Statin Therapy

Coronary atheroma regression was greater in women with coronary disease than in men when prescribed guideline-based statin therapy, results from an analysis of the Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) study suggested.

The analysis of intravascular ultrasound (IVUS) measures of coronary atheroma volume in patients from the SATURN study, published in JACC Cardiovascular Imaging, included 1,039 patients (274 of whom were women) treated with either rosuvastatin 40 mg or atorvastatin 80 mg during a 24-month study period.

Women had lower baseline percent atheroma volume (PAV) and total atheroma volume (TAV) than men. However, women also had greater PAV regression (–1.52±0.18% vs. –1.07±0.10%, p = 0.03) and TAV regression (–8.2±0.9 vs. –6.59±0.50 mm3, p = 0.11). Additionally, PAV regression was greater in women taking rosuvastatin, in women with diabetes, in those with stable coronary artery disease, in women with higher baseline LDL, and in those with higher CRP levels. A multivariable analysis suggested that the female sex was independently associated with PAV regression (p = 0.01).

"A significant interaction emerged between sex and treatment specification, with rosuvastatin-treated women demonstrating the greatest degree of plaque regression rates when on-treatment LDL values were above 70 mg/dl," the researchers wrote in the study. "However, women demonstrated significantly greater coronary atheroma regression than their male counterparts."

The researchers conceded that the reasons for the sex-treatment interaction were unclear, and warranted further research. Some of the reported limitations included a disparity in the number of women enrolled in the SATURN study, making the analysis a hypothesis-generating study. The analysis also did not apply to the primary prevention setting.

"These data support the use of high-intensity statin therapy in women with atherosclerotic cardiovascular disease, affirming recent treatment guidelines endorsing the use of potent statin therapy," the authors wrote in their conclusion. "In addition, dedicated clinical trials involving women may foster the development of personalized medicine."

Puri R, Nissen S, Shao M, et al. J Am Coll Cardiol. 2014 September 9. [Epub ahead of print]

Keywords: Pyrroles, Fluorobenzenes, Coronary Artery Disease, Plaque, Atherosclerotic, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Pyrimidines, Heptanoic Acids, Diabetes Mellitus, Precision Medicine, Sulfonamides

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