Another Telescope for Examining Statins: the SATURN Trial

Nicholls SJ, Ballantyne CM, Barter PJ, Chapman MJ, Erbel RM, Libby P, Raichlen JS, Uno K, Borgman M, Wolski K, Nissen SE: Effect of two intensive statin regimens on progression of coronary disease. N Engl J Med 365:2078–2087, 2011 Objective. The purpose of the Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) trial was to compare the effects of two intensive statin regimens on the progression of coronary atherosclerosis and to assess their safety and side-effect profiles. Design. Serial intravascular ultrasonography was performed in 1,039 patients with coronary disease at baseline and after 104 weeks of treatment with either atorvastatin, 80 mg daily, or rosuvastatin, 40 mg daily. The primary efficacy endpoint was percent atheroma volume (PAV) and the secondary efficacy endpoint was total atheroma volume (TAV). Results. At the end of 104 weeks of therapy, the rosuvastatin group had lower LDL cholesterol levels (62.6 vs. 70.2 mg/dl, P < 0.001) and higher HDL cholesterol levels (50.4 vs. 48.6 mg/dl, P = 0.01) than the atorvastatin group. The two regimens had a similar degree of regression of PAV, and rosuvastatin had a more favorable effect on TAV. Both agents induced regression in the majority of patients: 63.2% with atorvastatin and 68.6% with rosuvastatin for PAV ( P = 0.07) and 64.7% and 71.3%, respectively, for TAV ( P = 0.02). Both agents had acceptable side-effect profiles. Conclusion. Maximal doses of either rosuvastatin or atorvastatin resulted in significant regression of coronary atherosclerosis. Although rosuvastatin therapy resulted in lower LDL and higher HDL cholesterol levels than atorvastatin therapy, the two regimens brought about a similar degree of regression of PAV. Before specifically commenting on the SATURN trial, it is important to briefly review the pathophysiology and intravascular ultrasound (IVUS) study of atherosclerosis. As humans age, the development of atherosclerosis …