Common cardiovascular medications are finding uncommon uses, in some cases preventing heart disease even in low-risk patients and in other cases, protecting critically ill patients facing high-risk angioplasty and stenting procedures, according to research presented today at the American College of Cardiology's 56th Annual Scientific Session in New Orleans, La. ACC.07 is the premier cardiovascular medical meeting, bringing together cardiologists and cardiovascular specialists to further breakthroughs in cardiovascular medicine.
Effects of Ramipril and Rosiglitazone on Atherosclerosis: The Study of Atherosclerosis With Ramipril and Rosiglitazone (STARR) (Presentation Number: 404-6)
The STARR study will shed light on the potential for two common medications—ramipril and rosiglitazone—to slow the progression of atherosclerosis in patients at high risk for diabetes. STARR is a substudy of the Diabetes REduction Assessment with Ramipril and Rosiglitazone Medication (DREAM) trial, which earlier showed no significant improvement in the risk of heart attack, stroke, or cardiovascular death in patients with borderline glucose levels. However, the DREAM trial, with its focus on diabetes prevention, was not designed with the necessary statistical power to evaluate cardiovascular outcomes.
"STARR is expected to provide important information on the effect of these drugs on atherosclerosis progression and will complement the DREAM study findings," said Dr. Eva Lonn, a professor of medicine at McMaster University, Hamilton, Ontario, Canada.
Nearly 1,500 patients with either mildly elevated fasting glucose levels or an abnormal glucose tolerance test—but without diabetes or cardiovascular disease—were enrolled in STARR. They were randomly assigned to receive ramipril and rosiglitazone or their matching placebos. Ramipril is an angiotensin-converting-enzyme (ACE) inhibitor that has been shown to reduce the risk of heart attack and death in patients at high risk for cardiovascular disease. Rosiglitazone is a medication that improves blood glucose levels by improving the sensitivity of the body's cells to insulin.
STARR participants had ultrasound of the carotid arteries in the neck upon enrollment in the study and yearly after that. Ultrasound was used to measure the thickness of the arterial wall at 12 different locations in the carotid arteries (carotid intimal-medial thickness, or IMT), as an indicator of plaque build-up. Dr. Lonn and her colleagues will use the ultrasound results to analyze the effectiveness of ramipril and rosiglitazone in slowing the progression of atherosclerosis.
Dr. Lonn this study on Sunday, March 25, at 2:00 p.m. in Hall A.
Effect of Rosuvastatin on Progression of Carotid Intima Media Thickness in Low-Risk Individuals: Results of the METEOR Trial (Presentation Number: 404-8)
Two years' treatment with rosuvastatin was effective in slowing the build-up of arterial plaque in the arteries supplying blood to the brain in patients at low risk for cardiovascular disease, according to results of the Measuring Effects on intima media Thickness: an Evaluation Of Rosuvastatin (METEOR) study.
"The results of the METEOR trial demonstrate that even in very-low-risk, asymptomatic individuals with modest subclinical atherosclerosis, rosuvastatin treatment can beneficially affect the atherosclerotic process," said Dr. John R. Crouse III, a professor of internal medicine and public health sciences at Wake Forest University, Winston-Salem, NC. . The study will be simultaneously published in the Journal of the American Medical Association (JAMA) and will appear in the March 28 print issue.
The METEOR study recruited nearly 900 patients whose main risk factors for cardiovascular disease were a modest elevation in blood levels of LDL, or "bad" cholesterol, and a mild amount of plaque in the carotid arteries, detected by an ultrasound test that measures the thickness of the arterial wall in several places (intimal-medial thickness, or IMT). Patients were randomly assigned to take rosuvastatin 40 mg daily or a placebo. Rosuvastatin treatment was associated with a 49 percent reduction in LDL cholesterol levels and an eight percent increase in blood levels of HDL, or "good" cholesterol.
After two years, the overall change in the severity of atherosclerosis, as gauged by carotid ultrasound IMT, was significantly different in the rosuvastatin group (–0.0014 mm/year) when compared to the placebo group (+0.0131 mm/year; p < 0.0001). When only the common carotid segment was considered, the rosuvastatin group not only fared better than the placebo group, it experienced significant plaque regression in comparison to its own baseline.
Dr. Crouse this study on Sunday, March 25, at 2:30 p.m. in Hall A.
Atorvastatin Pretreatment Improves Outcome in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention. Results of the (Atorvastatin for Reduction of MYocardial Damage during Angioplasty-Acute Coronary Syndromes) Randomized Trial (Presentation Number 404-5)
In patients with acute coronary syndromes, high-dose atorvastatin given at least 12 hours before angioplasty or stenting appears to significantly reduce the risk of major cardiovascular complications within one month of the procedure.
"Statins are not usually considered part of the pharmacological armamentarium of the interventional cardiologist. In this study we demonstrate that they should be," said Dr. Germano Di Sciascio, a professor and chairman of cardiology and director of cardiovascular sciences, Campus Bio-Medico, University of Rome, Italy. The ARMYDA-ACS study will be published in the March 27, 2007, issue of the Journal of the American College of Cardiology (JACC).
The study focused on 170 patients with acute coronary syndromes (ACS), an umbrella term that encompasses unstable chest pain and a type of heart attack known as non-ST elevation myocardial infarction (NSTEMI). An earlier ARMYDA study of patients with stable chest pain showed that one week's pre-treatment with 40 mg atorvastatin reduced heart damage during routine angioplasty and stenting.
In ARMYDA-ACS, Dr. Di Sciascio and his colleagues randomly assigned patients with ACS to receive a placebo or double-dose atorvastatin (80 mg) 12 to 24 hours before going to the catheterization laboratory for angioplasty or stenting, followed by another 40 mg just before the procedure. Afterward, all patients received long-term atorvastatin therapy (40 mg/day).
Within the next month, only five percent of patients in the atorvastatin group experienced a heart attack, needed another coronary intervention or bypass surgery, or died, as compared to 17 percent in the placebo group. When multiple patient variables that might have influenced the results were taken into account, pretreatment with atorvastatin reduced the combined risk of one of these major cardiovascular complications by 88 percent (p=0.004). Most of the improvement was accounted for by a significant reduction in the risk of heart attack.
Dr. Di Sciascio said that although statins are usually prescribed for cholesterol lowering, their ability to reduce arterial inflammation and improve the function of blood vessels probably accounted for their benefit in patients with ACS. "The most important finding of the study is that a short-term atorvastatin load prior to coronary intervention in patients with ACS improves clinical outcome," he said.
Dr. Di Sciascio will present this sundayon Sunday, March 25, at 1:45 p.m. in Hall A.
The American College of Cardiology (www.acc.org) represents the majority of board certified cardiovascular physicians in the United States. Its mission is to advocate for quality cardiovascular care through education, research, promotion, development and application of standards and guidelines- and to influence health care policy. ACC.07 and the i2 Summit is the largest cardiovascular meeting, bringing together cardiologists and cardiovascular specialists to share the newest discoveries in treatment and prevention, while helping the ACC achieve its mission to address and improve issues in cardiovascular medicine.