Key result
Intensive rosuvastatin slows carotid IMT progression by ~75% vs. conventional pravastatin at 12 months.
Why the study?
Does intensive lipid-lowering therapy with rosuvastatin reduce the progression of carotid IMT compared to conventional therapy with pravastatin in Japanese subjects under primary prevention?
RCT (n=265)
Open-label, blinded-endpoint (PROBE)
Dynamic allocation method
Yes
Does intensive lipid-lowering therapy with rosuvastatin reduce the progression of carotid IMT compared to conventional therapy with pravastatin in Japanese subjects under primary prevention?
Intensive lipid-lowering therapy with rosuvastatin slows the progression of carotid intima-media thickness compared to conventional therapy in Japanese patients undergoing primary prevention.
Intensive statin therapy was associated with slower IMT progression in primary prevention; leaves open need for outcome trials before changing practice.
AIM: This subanalysis aimed to clarify whether intensive lipid-lowering therapy with statins slows the progression of atherosclerosis in Japanese subjects under treatment for primary prevention of cardiovascular disease. METHODS: This was a subanalysis of the Justification for Atherosclerosis Regression Treatment (JART) Study. We compared the efficacy of intensive lipid-lowering therapy and conventional therapy with respect to changes in the mean intima-media thickness (IMT) and serum lipid levels. We also evaluated changes in the mean IMT over 24 months of treatment and assessed the relationship between these changes and reductions in the LDL-C levels using a post-hoc analysis. RESULTS: Intensive lipid-lowering therapy with rosuvastatin was associated with significantly smaller changes in the mean IMT and a greater reduction in the serum lipid levels in comparison to conventional therapy with pravastatin. The average net change in the mean IMT was 0.010 mm (n=121) at 12 months and -0.004 mm (n=56) at 24 months. A decrease in LDL-C was found to be associated with a smaller change in the mean IMT (p=0.0009; Jonckheere-Terpstra trend test). A greater reduction in serum LDL-C was found to be associated with a smaller change in the mean IMT. Similar associations were observed for the serum TC and non-HDL-C levels and LDL-C/HDL-C ratio. There were no notable differences in the incidence of serious adverse events among the LDL-C quartiles. CONCLUSIONS: Lowering the LDL-C level with intensive lipid-lowering therapy is associated with reduced changes in the IMT among Japanese subjects at moderate to high risk under treatment for primary prevention. Subjects suitable for primary prevention may receive cardiovascular benefits from intensive lipid-lowering therapy, in association with significantly slower IMT progression than that observed with conventional therapy.
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Daida et al. (2014) conducted an RCT in Hypercholesterolemia requiring primary prevention of cardiovascular disease (n=265). Rosuvastatin vs. Pravastatin was evaluated on Change in mean carotid intima-media thickness (IMT) at 12 months (p=0.011). Intensive lipid-lowering therapy with rosuvastatin significantly slowed the progression of mean carotid intima-media thickness compared to conventional therapy with pravastatin (0.010 mm vs 0.040 mm, p=0.011) at 12 months.
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