Lowering Lipids In Atheroma; MAAS

Long-term treatment with the HMG-CoA reductase inhibitor simvastatin (Merck & Co's Zocor) reduces hyperlipidemia and slows the progression of diffuse and focal coronary atherosclerosis, according to the results of the Multicentre Antiatheroma Study (MAAS), which have just been published in The Lancet (September 3).

A total of 381 patients, who had angina or previously had myocardial infarction, were randomized to receive simvastatin (20mg daily) or placebo treatment over a study period of four years. The patients were enrolled at 11 centers across Europe. A coronary angiogram was made at the start of the study, another was carried out at two years and a third after four years. The extent of the obstructive atheromatous lesions was measured objectively in a central laboratory in Rotterdam, the Netherlands, on all three occasions by a computer-assisted angiographic analysis system.

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 to the placebo group over the four-year period. Looking at the antiatheroma effects of the drug, the researchers found that patients on placebo had a decrease in mean diameter of the vessel lumen and an increase in mean diameter of stenosis of 3.6%. For simvastatin, the mean lumen diameter increased and mean diameter of stenosis decreased by 2.6%. These treatment effects were seen regardless of the diameter of the stenosis at baseline, said the investigators.