Since we are on the topic of the ASTEROID trial and rosuvastatin, I'd make one more point before I start to sound like I'm plugging this drug (which I definitely am not).

In an informative Roundtable Discussion (open to subscribers to the American Journal of Cardiology; sorry) amongst Dr. Steve Nissen, principal investigator behind ASTEROID; and Drs. Vincent Friedewald, Christie Ballantyne, P. Shah, and William Roberts, Dr. Nissen made some interesting comments:

Dr. Shah: In ASTEROID, was the magnitude of atheroma volume change seen across different levels of LDL-C and HDL-C?

Dr. Nissen: No. There was no plaque regression seen in the 17 persons with LDL-Cs >/= 100 mg/dl, and there was little change in persons with LDL-Cs of 70 to 100 mg/dl. Only in persons with LDLs less than or equal to 70 mg/dl was there significant regression. The study was not powered to look for an HDL-C(which increased by 14.7%)-raising effect.

Interesting. In other words, ASTEROID, in a fairly internally consistent way, suggests that the lower the LDL is reduced, the more likely plaque regression is obtained. This is consistent with the Track Your Plaque experience, in which we've advocated reducing (calculated) LDL cholesterol to 60 mg/dl for the past several years.

Unfortunately, the message that the ASTEROID Trial sponsors, AstraZeneca, as well as the roundtable discussion panel (later in the discussion) try to make is that there is something magical about Crestor, that it yields benefits superior to other statin agents or other means of reducing LDL.

I disagree with this message. In the Track Your Plaque experience, we do aim for a similar LDL target. But we also employ a number of other strategies. We have also succeeded in regressing plaque without use of any statin drugs (though, admittedly, many people do require statin drugs to obtain LDLs in this range). We also witness magnitudes of reversal that often far exceed that seen in ASTEROID.

The Rountable Discussion is unfortunately tainted, as is the ASTEROID Trial itself, with deep drug industry financial involvement of the Roundtable participants. In fact, the discussion begins with a listing of the financial disclosures of the participants, a listing that occupies a full column of a two-column page. The potential biases of the participants doesn't necessarily invalidate the arguments, but to me suggests that participants are more likely to argue in favor of the sponsor's drug, or that participants were chosen because of these biases.

Why bother to even mention the ASTEROID Trial in a venue (the Heart Scan Blog, that is) that purports to seek unvarnished, unbiased truth in coronary plaque reversal? Because useful information can sometimes be found in unlikely places. Just like the four-year old child who blurts out an unexpected pearl of wisdom, so it can happen with the gobbledy-gook that emerges from the drug industry.

Every once in a while, they are worth paying attention to.

Comments (3) -

  • Naruwan

    4/19/2008 11:54:00 AM |

    Dr. Davis, your readers may be interested to listen to a recent BBC Radio 4 program which takes a close look at some impressive-sounding figures obtained from statin drug trials and shows how they are in fact not in the least bit impressive (e.g. a reduction in mortality from 3 in 600 people to 2 in 600 being hyped by statin manufacturers as being an over 33% reduction! Brings to mind Disraeli's adage about damned lies and statistics.

    The take home message is that statins appear to be hugely over-subscribed - the UK is gaining on the US in this regard - and statins are of no benefit for 99% of people taking them for primary prevention of heart disease.

    You can listen to the program online using the BBC Real Player at this link. Click Listen Live at the top right of the screen.

  • Naruwan

    4/19/2008 12:11:00 PM |

    My apologies, it appears that the BBC radio 4 program (The Investigation) about statins is no longer available. I think the show's transcript will be made available in due course.

    If anyone would like me to send them the mp3 file of the show (shhh, don't tell the BBC!), please leave a comment here. It's a worthwhile listen.

  • Anonymous

    8/22/2008 8:41:00 PM |

    I would like to know how long one can expect to lengthen their life by taking a statin How many actual years does it add to your life and what about the risk of cancer from taking statins over a 20-30 year period?