A GALAXY of Trials
The skies over Crestor brightened for good in March 2006 with publication of the results of AstraZeneca's ASTEROID trial in
the Journal of the American Medical Association. The data showed for the first time that a statin could reverse the progression of atherosclerosis (inflamed arteries due
to the accumulation of macrophages caused by plaque buildup), the leading cause of heart attack and stroke, and a condition
afflicting an estimated 4.5 million Americans. Crestor also reduced LDL by 53 percent and upped HDL by 15 percent—the best
performance by any statin.
ASTEROID was led by Steven Nissen, MD, a star cardiologist at the Cleveland Clinic and frequent critic of drug safety. "The
results were shockingly positive," he told The New York Times. But because the study did not measure outcomes, naysayers were quick to point out that Crestor's feat of reducing arterial
fat deposits by 7 to 9 percent may not decrease cardio events. Nissen disagreed. "You get rid of the lipid, and what's now
left is the fibrous material, which won't rupture," he said. "It's a stable scar—there is nothing to cause morbidity or mortality."
AZ followed up with METEOR, basically ASTEROID with a bigger, healthier population. METEOR enrolled close to 1,000 people
with only one risk factor for heart disease, but who were showing early-stage athero. Asymptomatic, these people would go
untreated; for some, the first sign of disease would be a heart attack or stroke.
Using ultrasound, METEOR showed that there was essentially no increase in artery-wall thickness in the Crestor group, while
in the placebo group atherosclerosis continued unchecked. It offered one remarkable take-away: Though Crestor failed to reduce
plaque, it put the brakes on further buildup. Equally important, LDL dropped 49 percent, while HDL rose 8 percent compared
As their names suggest, ASTEROID, METEOR, and JUPITER were related, part of the GALAXY program conceived when the molecule
was in its preclinical stage. "We thought hard about how we could fulfill the promise that a high level of potency could deliver,"
says Alex Gold, MD, Crestor development brand leader. "So we began developing a program of trials—some with surrogate endpoints,
others that were outcomes trials, to test Crestor against the entire range of cardiovascular problems."
With its plaque-slowing indication, AstraZeneca began moving the needle beyond highest risk patients. But as a real game-changer,
Crestor's cholesterol-lowering prowess was not sufficient. Nothing extends a brand like finding a new disease to treat—but
finding a new group of untreated patients at risk for the same old disease works just as well.
"Building" the Brand
In November 2007, FDA approved AZ's application for a second indication for Crestor, to treat atherosclerosis, based mainly
on ASTEROID and METEOR data. AstraZeneca lost no time in promoting Crestor as the only statin proven to slow progression of
In an effort to spur a grassroots educational campaign to raise awareness of atherosclerosis, AZ launched a campaign, "Us
Against Athero," whose Web site (
http://usagainstathero.com/) offers the latest in interactivity. Its most fetching feature is the animated "Artery Explorer" movie, a Fantastic Voyage-like visualization of athero doing its dirty work. The Artery Explorer is also the name of the trailer, equipped with an
eight-person motion simulator, that travels nationwide to offer communities a visceral lesson in the dangers of athero. The
Web site also includes a three-part film about risk, prevention, treatment, and advocacy, and "Athero News," a Cardio 101
from the Mayo Clinic.
"There wasn't anything else out there to help people understand atherosclerosis—what cholesterol had to do with it, and what
it has to do with heart disease," says Crestor commercial brand leader Lisa Nanfra.
Branded print ads and TV commercials feature what the ad press has taken to describing as a "busy Boomer chef," too smart,
too healthy, and too darn busy to worry about heart attack or stroke. Early-stage atherosclerosis, however, is another matter.
"While you've been building your life," she says, "Plaque may have been building in your arteries." The simple repetition
of "building" is an inspired stroke, linking the positive associations of responsible adulthood to the body's natural process
of laying down arterial plaque.
The Crestor campaign wins high marks for innovation from the pros. "The future of DTC is in detailing to patients the way
pharma has traditionally detailed to doctors," says Rob Dhoble, president, DAS Healthcare, Omnicom Group. "You turn the brand
promise into a scientific discussion that a lay person can understand. The Crestor campaign accomplishes that in a very effective