Comparison of Effects of Atorvastatin (20 mg) Versus Rosuvastatin
(10 mg) Therapy on Mild Coronary Atherosclerotic Plaques
(from the ARTMAP Trial)
Cheol Whan Lee, MD, Su-Jin Kang, MD, Jung-Min Ahn, MD, Hae Geun Song, MD,
Jong-Young Lee, MD, Won-Jang Kim, MD, Duk-Woo Park, MD, Seung-Whan Lee, MD,
Young-Hak Kim, MD, Seong-Wook Park, MD, PhD, and Seung-Jung Park, MD, PhD*
High-dose rosuvastatin induces regression of coronary atherosclerosis, but it remains
uncertain whether usual-dose statin has similar effects. We compared the effects of ator-
vastatin 20 mg/day versus rosuvastatin 10 mg/day on mild coronary atherosclerotic plaques
(20% to 50% luminal narrowing and lesion length >10 mm) using intravascular ultrasound
(IVUS). Three hundred ﬁfty statin-naive patients with mild coronary atherosclerotic
plaques were randomized to receive atorvastatin 20 mg/day or rosuvastatin 10 mg/day.
IVUS examinations were performed at baseline and 6-month follow-up. Primary end point
was percent change in total atheroma volume (TAV) deﬁned as (TAV at 6 months ؊ TAV
at baseline)/(TAV at baseline) ؋ 100. Evaluable IVUS was obtained for 271 patients
(atorvastatin in 143, rosuvastatin in 128). Clinical characteristics, lipid levels, and IVUS
measurements at baseline were similar between the 2 groups. At 6-month follow-up,
percent change in TAV was signiﬁcantly less in the atorvastatin group than in the
rosuvastatin group (؊3.9 ؎ 11.9% vs ؊7.4 ؎ 10.6%, respectively, p ؍ 0.018). In contrast,
change in percent atheroma volume was not different between the 2 groups (؊0.3 ؎ 4.2 vs
؊1.1 ؎ 3.5, respectively, p ؍ 0.157). Compared to baseline, TAV and TAV at the most
diseased 10-mm subsegment were signiﬁcantly decreased in the 2 groups (p <0.001).
Changes in lipid proﬁles at 6-month follow-up were similar between the 2 groups. In
conclusion, usual doses of atorvastatin and rosuvastatin induced signiﬁcant regression of
coronary atherosclerosis in statin-naive patients, with a greater decrease in favor of
rosuvastatin. © 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;109:
Atorvastatin (10 to 20 mg/day) and rosuvastatin (10
mg/day) are commonly prescribed to prevent recurrent cor-
However, little is known about whether this
approach is as effective as high-dose statin therapy and
whether plaque regression differences exist according to
type of statin used. In the present study, we compared the
effects of atorvastatin versus rosuvastatin therapy with
equivalent potency on mild coronary atherosclerotic plaques
using intravascular ultrasound (IVUS; atorvastatin versus
rosuvastatin therapy with equivalent potency on mild coro-
nary atherosclerotic plaques [ARTMAP] trial).
ARTMAP is a prospective, single-center, open-label,
randomized comparison trial involving statin-naive patients
Ն18 years old with clinically indicated percutaneous coro-
nary intervention from September 2004 through June 2009.
Patients were included if they had Ն1 atherosclerotic plaque
with 20% to 50% luminal narrowing and lesion length Ͼ10
mm in a coronary artery by visual assessment that had not
been subjected to intervention. Exclusion criteria included
coronary artery bypass graft surgery, valvular heart disease,
left ventricular ejection fraction Ͻ40%, any heart failure,
renal insufﬁciency (serum creatinine Ͼ1.5 mg/dl), active
liver disease, and any statin therapy in the previous 4 weeks.
The study protocol was approved by our institutional review
committee. All patients provided written informed consent.
Patients were randomized to receive atorvastatin 20 mg/
day or rosuvastatin 10 mg/day after IVUS examination. The
randomization code was generated by computer, and the
study drug was administered after the procedure. Biochem-
ical laboratory tests were performed at the time of admis-
sion and at 1- and 6-month follow-up periods. All patients
were clinically monitored by laboratory measurements at 1
month and 3 and 6 months. Routine coronary angiography
and IVUS examination at 6 months were requested for all
The longest and least angulated target vessel meeting the
inclusion criteria was selected. The region of interest was
ﬂanked by 2 anatomic landmarks (side branches) that were
easily identiﬁable at follow-up. After intracoronary admin-
istration of nitroglycerin 0.2 mg, IVUS imaging was per-
formed using a motorized transducer pullback system (0.5
Department of Medicine, Asan Medical Center, University of Ulsan,
Seoul, Korea. Manuscript received January 8, 2012; revised manuscript
received and accepted January 30, 2012.
This study was supported by a grant from CVRF, Seoul, Korea, and
Grant A090264 from the Ministry of Health and Welfare, Seoul, Korea.
*Corresponding author: Tel: 82-2-3010-3150; fax: 82-2-486-5918.
E-mail address: email@example.com (S.-J. Park).
0002-9149/12/$ – see front matter © 2012 Elsevier Inc. All rights reserved. www.ajconline.org