SATURN AND THE WHOLE ISSUE OF PLAQUE REGRESSION

At the just concluded AHA annual scientific meeting at Orlando, Florida, one of thelate breaking trial was SATURN, or Study of coronary atheroma by intravascular ultrasound: Effect of rosuvastatin and atorvastatin. Led by Dr Stephen Nicholls of Cleveland clinic, they began to enrol patients in 2008. A total of 1385 patients were enrolled. They all had established coronary artery disease and were scheduled for coronary angiogram, when IVUS was also carried out, at day 0 and day 104 weeks. This was a double blind trial comparing rosuvastatin 40 mg and atorvastatin 80 mg. The primary endpoint was PAV ( plaque atheroma volume on IVUS ) regression. They also had secondary endpoints of LDL-C lowering and HDL-C elevation.
It was obvious after 104 weeks, that both statin at that dose regress plaques, similarly to about 1% ( not alot ). Rosuvastatin lowered LDL-C significantly better and increase HDL-C significantly better.
I am sure that the lipid lowering chararcteristics, we all know, what after JUPITER. What we were all surprised was the PAV regression, remembering that after REVERSAL ( the high dose atorvastatin 80mg trial with IVUS ), the plaques did not regress significantly, and also after JUPITER trial with Rosuvastatin, where the carotid intima did not regress significantly. It looks like SATURN is out of keeping with REVERSAL and JUPITER. It may be too good to be true. Anyway, PAV like carotid intima plaque regression are surrogate endpoints, which some of us find hard to correlate. We would rather prefer hard endpoints like death, or at least MACCE. Of course this will take too long and too costly to collect.
So, like many trials before it, SATURN tells me that Rosuvastatin and Atorvastatin lowers LDL-C and HDL-C well, at a dose that I would never use. What I did not see was the side effects. Not to forget that there are many trials that showed that at those doses or superdoses, I will get more muscle aches, pains, and even myo-necrosis, and of course liver dysfunction.
The Americans keep pushing their superdoses, maybe that is why their economy is in shambles. Perfection may be the enemy of good here.