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METEOR: Does Rosuvastatin Benefit Low-Risk Patients?

The drug slowed progression of carotid intima-media thickness, but cardiovascular outcomes were not assessed.

Do patients at low risk for cardiovascular disease (CVD) benefit from LDL lowering with rosuvastatin? To find out, researchers conducted a manufacturer-sponsored, double-blind trial, known as METEOR, in which low-risk patients (mean age, 57) were randomized to receive rosuvastatin (40 mg/day; 702 patients) or placebo (282 patients) for 2 years. Carotid intima–media thickness (CIMT) was assessed, using ultrasound, before randomization and every 6 months for 2 years.

At baseline, all participants had 10-year Framingham risk scores <10% and mild to moderate CIMT (1.2 mm to <3.5 mm). LDL levels were <190 mg/dL in participants whose only CVD risk factor was older age and <160 mg/dL in those with multiple risk factors. The cohort’s overall mean LDL level was about 155 mg/dL.

During the 2-year study, LDL levels declined significantly more in the rosuvastatin group than in the placebo group (by 49% vs. 0.3%). The rate of change in maximum CIMT for 12 carotid sites (the primary endpoint) was significantly slower with rosuvastatin than with placebo (–0.0014 mm/year [regression] vs. +0.0131 mm/year [progression]). Treatment produced no significant regression of atherosclerosis burden. The frequency of side effects was similar between groups.

Comment: In this study, rosuvastatin treatment slowed progression of carotid intima-media thickness but did not induce significant regression. Although these findings are of interest, larger, longer-term trials are needed to determine whether rosuvastatin reduces the risk for actual cardiovascular events. For now, physicians should continue to consult current lipid-lowering guidelines for lower-risk patients, recalling that the AFCAPS/TexCAPS Study (which involved a similar group of patients) documented improved CVD outcomes with lovastatin (Journal Watch Cardiology Jul 10 1998).

— JoAnne M. Foody, MD

Published in Journal Watch Cardiology April 4, 2007

Citation(s):

Crouse JR III et al. for the METEOR Study Group. Effect of rosuvastatin on progression of carotid intima-media thickness in low-risk individuals with subclinical atherosclerosis: The METEOR trial. JAMA 2007 Mar 28; 297:1344-53.

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• Medline abstract (Free)

Lauer MS. Primary prevention of atherosclerotic cardiovascular disease: The high public burden of low individual risk. JAMA 2007 Mar 28; 297:1376-8.

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• Medline abstract (Free)