Coronary atherosclerosis can regress with very intensive statin therapy.

The ASTEROID trial (JAMA 2006; 295:1556-1565) showed that very intensive statin therapy with rosuvastatin 40 mg once daily results in highly significant regression of coronary atherosclerosis as assessed by serial intravascular ultrasonography (IVUS). The mean low-density lipoprotein cholesterol (LDL-C) level achieved with this regimen was 61 mg/dL, and the mean high-density lipoprotein cholesterol (HDL-C) level increased by 15%. While the merits of concomitant LDL-C-lowering and HDL-C-raising therapies remain to be determined, the results of the ASTEROID and other recent trials suggest that the optimal strategy for lipid-lowering in patients with coronary artery disease is to try for the lowest LDL-C level that can be attained without adverse effects.