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Cholesterol Management 101

with Michael Richman, MD, FACS

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Friday, October 7, 2011

Comparing Statins: The SATURN Trial

In early September, the results of a study known as the SATURN statin trial were released. Since that time, I have had several patients ask me which statin drug is the best to remove cholesterol plaques. Plaques lead to blockages from the arteries of the heart. This is a very interesting question that I have been asked before by many patients. The simple answer is that to date, there are no published studies that have looked at whether or not being able to remove plaques from arteries in the heart, also know as atheromas, can lower the chances of having a heart attack. This is known as outcome data.

I find myself spending more and more time with patients trying to explain what they heard or didn’t hear or read on television or the newspaper regarding cholesterol studies. There are many studies published every day on many different topics. The majority of the papers are not published in journals that are reviewed by doctors who practice in the same field as the paper’s author. These are what as known as “throw away” journals as the often lack credibility. Articles that are published in “peer-reviewed” journals are generally regarded as those that have undergone rigorous scrutiny before being accepted for publication.

With that as a background, I want to talk about SATURN. This trial compared two different statin drugs in 1,300 patients. It looked at how the drugs removed some plaque from the atheroma. Specifically, they looked at the change in atheroma volume before being treated with drugs and then after two years on treatment. They put a catheter in the heart arteries and used ultrasound to measure the change in the volume of the plaque.

The two statins compared were high dose Crestor and Lipitor. The results showed that the two statins were the same in the amount of plaque reduction, but a numerical result was not given. The information will be presented at the American Heart Association meeting in November.

The main reason I brought up this trial is because this study was just “a pretty picture”. What does this mean? It means that the authors had no outcome results to report. Although the plaque volume decreased, there is no data looking at if there was a reduction in non-fatal heart attacks, fatal heart attacks, or overall cardiovascular death.

So how does the information from the SATURN trial help us? In my view, it does’t provide us with any useful information until we can show that removing plaque will result in an outcome that will provide useful data which will result in a treatment that will change an outcome and benefit patients.

Posted by: Michael Richman, MD, FACS at 12:50 am

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