Abstract 15555: Sex-Related Differences of Coronary Atherosclerosis Regression Following Maximally Intensive Statin Therapy: Insights From SATURN
Background: Women are under-represented in clinical trials, leading to a gender-disparity for prescribing evidenced-based therapies. The efficacy of high-intensity statins in women is poorly understood. We explored rates of coronary atheroma progression in men and women prescribed maximally intensive statin therapy.
Methods: SATURN employed serial intravascular ultrasound (IVUS) measures of coronary atheroma volume in patients treated with rosuvastatin 40 mg or atorvastatin 80 mg for 24 months. The treatment groups did not differ significantly in change from baseline of percent atheroma volume (PAV) on IVUS, nor in safety or clinical outcomes.
Results: Compared with men (n=765), women (n=274) were older (59.2±9 vs. 57.1±9 yrs, p<0.001) and more likely to have hypertension (80.3 vs. 66.8%, p<0.001), diabetes mellitus (21.2 vs. 13.2%, p=0.002), and higher LDL-C (123.8±31 vs. 118.6±27 mg/dL, p=0.01), HDL-C (49.9±12 vs. 43.2±10 mg/dL, p<0.001) and CRP [1.8 (1.0, 4.1) vs. 1.5 (0.8, 3.3) mg/L, p=0.004] levels. At follow-up, women had higher HDL-C (54.3±12 vs. 47.6±11 mg/dL, p<0.001) and CRP [1.3 (0.7, 3.2) vs. 1.0 (0.5, 2.0) mg/L, p<0.001] levels, but similar LDL-C (66.8±25 vs. 65.1±22 mg/dL, p=0.46) levels compared with men. Compared to men, women had less PAV at baseline (34.0±8.0 vs. 37.2±8.2%, p<0.001), yet demonstrated greater PAV regression following treatment (-1.52±0.18 vs. -1.07±0.10%, p=0.03). Greater PAV regression in women versus men occurred in patients treated with rosuvastatin (p=0.004), and in those with diabetes mellitus (p=0.01), stable coronary disease (p=0.01), higher baseline LDL-C (p=0.02) and higher CRP (p=0.04) levels. On multivariable analysis, female sex independently associated with PAV regression (p=0.01) and a significant sex-treatment interaction was found (p=0.036). For participants with on-treatment LDL-C levels <70 mg/dL, women achieved greater PAV regression than men (-1.81±0.22%vs. -1.12±0.13%, p=0.007), whereas PAV regression did not differ by sex in those with LDL-C levels ≥70 mg/dL.
Conclusion: Women demonstrate greater plaque regression than men following high-intensity statin therapy, particularly when treated with rosuvastatin, and in those who achieve guideline-recommended LDL-C levels.
- © 2013 by American Heart Association, Inc.