Effect of Two Intensive Statin Regimens on Progression of Coronary Disease (SATURN Trial)

The SATURN (Study of Coronary Atheroma by IntraVascular Ultrasound: Effect of Rosuvastatin versus Atorvastatin) trial randomized 1,039 patients with CAD to maximum-intensity atorvastatin (80 mg) or rosuvastatin (40 mg) and tracked coronary plaque burden by IVUS over 104 weeks.

Both regimens produced significant plaque regression — a first in a head-to-head intensive statin trial. Rosuvastatin produced numerically greater reduction in LDL-C and greater increase in HDL-C, and achieved modestly greater atheroma regression, but the between-group difference in plaque volume was small and favored rosuvastatin only on some IVUS measures.

The SATURN trial established several important points. First, maximum-intensity statin therapy with either atorvastatin or rosuvastatin achieves plaque regression — not just halted progression. Second, the degree of LDL-C lowering correlated with the degree of plaque regression, consistent with the causal hypothesis. Third, HDL-C increase did not translate into additional plaque benefit beyond what LDL-C reduction alone predicted.

The IVUS endpoint is a validated surrogate; clinical event differences between the two regimens were not powered and were not observed.

We rate the evidence strong. A rigorous head-to-head IVUS trial confirming that maximum-intensity statin therapy produces measurable coronary plaque regression, with LDL-C as the primary driver.