Comparison of the efficacy of rosuvastatin versus atorvastatin in reducing apolipoprotein B/apolipoprotein A-1 ratio in patients with acute coronary syndrome: results of the CENTAURUS study
Jean-Marc Lablanche, Attilio Leone, Bela Merkely, João Morais, Joaquim Alonso, Massimo Santini, Jaan Eha, Nacima Demil, Muriel Licour, Jean-Claude Tardif, CENTAURUS investigators, F Albert, J Alonso Martín, P Asseman, E Aymong, J Ballout, A Bardají Ruiz, G Bayet, E Bearez, L Belle, E Benit, C Berlemont, V Bertomeu, D Blanchard, J L Bonnet, K Boughalem, E Boughzela, M R Boujnah, A Buffon, A Cardoso, P Cardoso, C Cavallini, H Celen, A -A Cohen, C Constance, P Coste, P Crean, P D Crochet, W Czarnecki, N Danchin, J -M Davy, E Decoulx, N Delarche, I De Luca, P Dubois, J -L Dubois-Rande, O Dubourg, J Ducas, V Dzavik, J Eha, D El Allaf, S Elhadad, N El Mansour, B Farah, F Fedele, F J Fernández Avilés, J Ferreira, D Foley, P Fong, K Gacem, P Garber, V L García, R Gendreau, N Ghanem, G Goulet, G Grollier, A Guiomard, C Gully, M Habis, H Haouala, P Henry, G Heyndrickx, I Horváth, W Hui, T Huynh Thanh, S Iliceto, A Iniguez Romo, F Jamal, L Janssens, M Jiménez Mena, I Kallikazaros, S Kassam, A Kermarrec, K Khalife, H Kim, R G Kiss, W P Klinke, R Koning, S Kouz, Z Kyriakides, A L'Abbate, R Labonte, S LaHaye, L Leborgne, M Le May, A Leone, S Lepage, G Lupkovics, A Martínez Martínez, B Meany, R Mechmech, J -P Melchior, B Merkely, D Metz, J Mimoso, G Montalescot, J Morais, I Moreira, G Mougeot, D Mulcahy, J Nanas, P Nash, O Nugue, L Rodríguez Padial, F Paganelli, M Palaic, L M Pereira, W Pitscheider, P Presbitero, J Puel, S Radhakrishnan, F Reeves, D Richter, J Rodes Cabau, P Rosak, B Rose, J -F Rousseau, M Santini, E Schampaert, M Scherillo, P Serrano Aisa, D Sugrue, C Tamburino, J C Tardif, P Teefy, P Timmerman, L Title, G Traisnel, B Tremblay, G Tremblay, B Trimarco, W Tymchak, L Vándor, C Vassanelli, G Veress, J Voitk, J -E Wolf, G Wong, K Zámolyi, R Zanini, R Zimmermann, Jean-Marc Lablanche, Attilio Leone, Bela Merkely, João Morais, Joaquim Alonso, Massimo Santini, Jaan Eha, Nacima Demil, Muriel Licour, Jean-Claude Tardif, CENTAURUS investigators, F Albert, J Alonso Martín, P Asseman, E Aymong, J Ballout, A Bardají Ruiz, G Bayet, E Bearez, L Belle, E Benit, C Berlemont, V Bertomeu, D Blanchard, J L Bonnet, K Boughalem, E Boughzela, M R Boujnah, A Buffon, A Cardoso, P Cardoso, C Cavallini, H Celen, A -A Cohen, C Constance, P Coste, P Crean, P D Crochet, W Czarnecki, N Danchin, J -M Davy, E Decoulx, N Delarche, I De Luca, P Dubois, J -L Dubois-Rande, O Dubourg, J Ducas, V Dzavik, J Eha, D El Allaf, S Elhadad, N El Mansour, B Farah, F Fedele, F J Fernández Avilés, J Ferreira, D Foley, P Fong, K Gacem, P Garber, V L García, R Gendreau, N Ghanem, G Goulet, G Grollier, A Guiomard, C Gully, M Habis, H Haouala, P Henry, G Heyndrickx, I Horváth, W Hui, T Huynh Thanh, S Iliceto, A Iniguez Romo, F Jamal, L Janssens, M Jiménez Mena, I Kallikazaros, S Kassam, A Kermarrec, K Khalife, H Kim, R G Kiss, W P Klinke, R Koning, S Kouz, Z Kyriakides, A L'Abbate, R Labonte, S LaHaye, L Leborgne, M Le May, A Leone, S Lepage, G Lupkovics, A Martínez Martínez, B Meany, R Mechmech, J -P Melchior, B Merkely, D Metz, J Mimoso, G Montalescot, J Morais, I Moreira, G Mougeot, D Mulcahy, J Nanas, P Nash, O Nugue, L Rodríguez Padial, F Paganelli, M Palaic, L M Pereira, W Pitscheider, P Presbitero, J Puel, S Radhakrishnan, F Reeves, D Richter, J Rodes Cabau, P Rosak, B Rose, J -F Rousseau, M Santini, E Schampaert, M Scherillo, P Serrano Aisa, D Sugrue, C Tamburino, J C Tardif, P Teefy, P Timmerman, L Title, G Traisnel, B Tremblay, G Tremblay, B Trimarco, W Tymchak, L Vándor, C Vassanelli, G Veress, J Voitk, J -E Wolf, G Wong, K Zámolyi, R Zanini, R Zimmermann
Abstract
Background: The mechanism underlying statin-induced event reduction in patients with acute coronary syndrome remains unclear.
Aims: To assess the efficacy of rosuvastatin 20mg versus atorvastatin 80 mg in reducing the apolipoprotein B/apolipoprotein A-1 (apoB/apoA-1) ratio at 3 months. Non-inferiority of rosuvastatin 20mg versus atorvastatin 80 mg in reducing low-density lipoprotein cholesterol at 1 and 3 months was also assessed.
Methods: Patients with non-ST-elevation acute coronary syndrome were enrolled into this randomized, double blind, parallel-group trial.
Results: In total, 753 patients (369, rosuvastatin 20mg; 384, atorvastatin 80 mg) were included in the intention-to-treat analysis; 478 patients (226, rosuvastatin 20mg; 252, atorvastatin 80 mg) were included in the per-protocol analysis. Rosuvastatin 20mg was more effective than atorvastatin 80 mg in decreasing apoB/apoA-1 ratio at 1 month (-44.4% vs -42.9%, p=0.02) but not at 3 months (both -44.4%, p=0.87). Low-density lipoprotein cholesterol decreased by approximately 50% after 1 and 3 months in both groups. Non-inferiority of rosuvastatin 20mg versus atorvastatin 80 mg was demonstrated at 1 month (difference, -0.3% [95% confidence interval, -2.7; +2.1]), but not at 3 months (+1.0% [-1.6; 3.5]) (intention-to-treat analysis). In the per-protocol analysis, non-inferiority of rosuvastatin 20mg was demonstrated at both 1 (-0.7% [-3.5; 2.0]) and 3 (-0.5% [-3.5; 2.5]) months.
Conclusion: In patients with non-ST-elevation acute coronary syndrome, rosuvastatin 20mg decreased apoB/apoA-1 ratio at 1 month more than atorvastatin 80 mg. No difference could be shown at 3 months; thus, the primary endpoint was not met.
Trial registration: ClinicalTrials.gov NCT00296387.
Source: PubMed