Wednesday, April 18, 2007


I must say that I was so captured by all the implications with "COURAGE" that I did not quite see the article on METEOR. METEOR (Measuring Effects on intima media Thickness: an Evaluation of Rosuvastatin), was presented at the just concluded ACC meeting in New Orleans (25th March 2007).

Dr JR Crouse III and team examine the effects of 40mg of Rosuvastatin on asymptomatic, low CVS risk patients, to see if Rosuvastatin at 40mg, will regress cholesterol plaques, as measured by B-mode ultrasound. The investigators found that Rosuvastatin at that dose did halt plaque progression with a trend to regression. The findings mirrored that of "REVERSAL", (the study of Pfizer, where lipitor at 80mg daily also halt plaque progression, with a trend to regression).

Although the results were not unexpected, a few comments are noteworthy. Firstly, the investigators studied about 900 patients. I wondered why. It should have been fairly easy to recruit asymptomatic, low risk patients. I was hoping that it would be thousands or tens of thousands of patients. Then again, they divided the patients into 200+ in the placebo group and 700+ in the treatment arm. I suppose, they were not keen to give placebo (no statins) in this arm for fear of litigation. Then again, the investigators decided to use B-mode ultrasound, instead of a duplex ultrasound, which to my mind, is a more accurate method. B-mode ultrasound seems rather archaic. Anyway, I think that rosuvastatin (like lipitor), at this dose of 40 mg, does halt progression of atherosclerosis. It is also good to remember that this is a ultrasound study and not a clinical events study.

There must be some concern on using 40mg Rosuvastatin, as this high dose has been associated with higher incidence of muscle problems and renal problems. In fact, in Asians, we would prefer to use 5-20mg, to play it safe, so to speak. It is fair to comment that superstatins, especially at superdoses, will halt atherosclerosis and hopefully, reduce MACCE. I will venture a little further by saying that in asymptomatic low risk patients, superstatins are better then angioplasty (The lesson from COURAGE). And also, that all those people going for 64MSCT may do better just taking superstatins at reasonable doses. But then again, if I owned a 64MSCT, I may not be singing this tune.

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