Low cholesterol drugs at high dose significantly reduce heart attacks strokes and deaths

Main Category: Cholesterol
Article Date: 09 Mar 2004 - 0:00 PST

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If you have heart disease you are less likely to have a heart attack, stroke or die if you take high doses of cholesterol lowering drugs (statins). This is according to a new study.

Experts have been debating and wondering whether more aggressive use of statins help more people avoid heart attacks and strokes (and ultimately death).

This study, which was concluded yesterday, will have a major impact on doctors' decisions on how aggressively to treat their patients with severe heart problems. They will probably increase their dosage of statins.

You might also see, as a result of this study, that patients who are not currently on them will be prescribed statins.

The reason for boosting dosage is to bring cholesterol levels down even lower. It seems, according to the study, that if you push cholesterol levels even lower than the current aims have been for patients with severe heart problems, you protect the patient even more from heart attacks and strokes and death.

This is a breakthrough, say some experts, to show that lowering cholesterol to very low levels is better for the patient.

Eric Topol, who has written an article which goes alongside the study says "this is a sea change..." Eric Topol is Chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic in Ohio.

You will be able to read about this study in the New England Journal of Medicine (April 8 issue).

In the USA, 64 million people have cardiovascular disease. There are about 1.4 million deaths each year in the USA attributable to cardiovascular disease.

The current number of 11 million Americans taking statins could more than double as a result of this study.

Many experts have been saying that patients could be further protected if their cholesterol levels were lowered even more than the current guidelines. Health experts were hesitant to do this until they saw proof. There have been indications that there are rare cases of liver problems.

Well, it seems that now the proof has arrived regarding the benefits of fighting cholesterol aggressively.

This new study involved 4,162 patients, in 8 different countries at 349 sites. All the patients had been taken to the emergency room as the result of a heart attack or severe chest pain.

The study was led by Dr. Christopher Cannon, a cardiologist at the Brigham and Women's Hospital in Boston, USA.

Doctors started giving the patients in the trial either 40 milligrams a day of Pravachol (a statin by Bristol-Myers Squibb) or 80 milligrams a day of Lipitor (statin by Pfizer). The Lipitor is usually prescribed at about 10-20 milligrams a day.

They then monitored patients' cholesterol levels and LDL (low-density lipoprotein). LDL is known as the 'bad protein'.

LDL levels should be brought down to below 100 milligrams per deciliter (current guidelines say).

Patients who had been on the Pravachol at 40 milligrams per day experienced a 25% drop in LDL levels to 95 (on average). Those on Lipitor at 80 milligrams a day experienced a 50% fall to an LDL level of 62.

Those who had been on Lipitor at the high dose over a period of two-and-a-half years were 16% less likely to suffer chest pain, need angioplasty or need a bypass. They were also 16% less likely to have another heart attack or a stroke. Their risk of death was 28% less.

It seemed that women fared even better than men in this trial.

The patients were monitored from day one of the trial for the whole period of two and a half years.

This is all well and good for Lipitor, but what about other statins? In all likelihood, the same will probably apply to all statins at high doses. Currently, there are three other trials to see how other statins do.

This main study was funded by Bristol-Myers Squibb.

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