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Effect of simvastatin on coronary atheroma: the Multicentre Anti-Atheroma Study (MAAS)
Insights
Simvastatin significantly slowed coronary atherosclerosis progression in patients with coronary heart disease over 4 years. This cholesterol-lowering drug reduced hyperlipidemia and improved angiographic outcomes without affecting clinical events.
Area of Science:
- Cardiology
- Pharmacology
- Medical Research
Background:
- Coronary atherosclerosis progression and its management remain critical areas in cardiovascular disease research.
- The impact of substantial plasma lipid reduction on coronary atheroma progression requires further investigation.
Purpose of the Study:
- To evaluate the effect of simvastatin on the progression of diffuse and focal coronary atheroma in patients with coronary heart disease.
- To assess the efficacy of simvastatin in reducing plasma lipids and its impact on coronary atherosclerosis over a 4-year period.
Main Methods:
- A randomized, double-blind, placebo-controlled trial (Multicentre Anti-Atheroma Study - MAAS) involving 381 patients.
- Patients received either simvastatin 20 mg daily or placebo for 4 years, alongside diet.
- Quantitative coronary angiography was performed at baseline and after 2 and 4 years to assess changes in coronary arteries.
Main Results:
- Simvastatin treatment resulted in significant reductions in serum cholesterol (-23%) and low-density lipoprotein cholesterol (-31%), with a 9% increase in high-density lipoprotein cholesterol compared to placebo.
- Angiographic analysis showed simvastatin slowed the progression of coronary atherosclerosis, with beneficial effects on mean and minimum lumen diameter and diameter stenosis.
- Fewer patients on simvastatin experienced angiographic progression, new lesions, or total occlusions, while regression was more frequent compared to the placebo group.
Conclusions:
- Daily simvastatin (20 mg) over 4 years effectively reduces hyperlipidemia in patients with coronary heart disease.
- Simvastatin significantly slows the progression of both diffuse and focal coronary atherosclerosis as evidenced by quantitative coronary angiography.
- While simvastatin demonstrated clear benefits in slowing atherosclerosis progression, no significant differences in clinical outcomes like death or myocardial infarction were observed between groups during the trial period.
Abstract:
It has yet to be established whether substantial reduction of plasma lipids will lead to retardation, and to what extent and how quickly, of diffuse and focal coronary atheroma. The Multicentre Anti-Atheroma Study (MAAS) is a randomised double-blind clinical trial of 381 patients with coronary heart disease assigned to treatment with diet and either simvastatin 20 mg daily or placebo for 4 years. Patients on simvastatin had a 23% reduction in serum cholesterol, a 31% reduction in low-density lipoprotein cholesterol, and a 9% increase in high-density lipoprotein cholesterol compared with placebo over 4 years. Quantitative coronary angiography was done at baseline, and after 2 and 4 years. 167 patients (89%) on placebo and 178 (92%) on simvastatin had baseline and follow-up angiograms. In the placebo group there were reductions in mean lumen diameter (-0.08 mm) and in minimum lumen diameter (-0.13 mm). Treatment effects were +0.06 (95% CI 0.02 to 0.10) and +0.08 mm (0.03 to 0.14) for mean and minimum lumen diameter, respectively (combined p = 0.006). Patients on placebo had an increase in mean diameter stenosis of 3.6% and the treatment effect of simvastatin was -2.6% (-4.4 to -0.8). Treatment effects were observed regardless of diameter stenosis at baseline. On a per-patient basis, angiographic progression occurred less often in the simvastatin group, 41 versus 54 patients; and regression was more frequent, 33 versus 20 patients (combined p = 0.02). Significantly more new lesions and new total occlusions developed in the placebo group, 48 versus 28, and 18 versus 8, respectively. There was no difference in clinical outcome. The numbers of patients who died or had a myocardial infarction were 16 and 14 in the placebo and simvastatin groups, respectively. In the placebo group more patients underwent coronary angioplasty or re-vascularisation, 34 versus 23 on simvastatin. The trial showed that 20 mg simvastatin daily over 4 years reduces hyperlipidaemia and slows progression of diffuse and focal coronary atherosclerosis.