In a recent study it has been found that cholesterol therapy using multiple drugs over an extended period may be more effective than taking a single statin medication. In previous studies the benefits of using a combination of two or three drugs aimed to aggressively lower LDL (bad cholesterol) and raise HDL (good cholesterol) have been mentioned. This is the first one to show long term benefits over a period of 20 years.
Patients who received a combination drug-therapy had much lower levels of LDL and triglycerides as well as higher HDL and less fatty buildup in the carotid artery.
Loyola University Health System cardiologist Binh An P. Phan, MD, FACC was the lead author of this study and also presented it at the National Lipid Association 2012 Annual Scientific Sessions. At the beginning of the study, both groups had similar fatty buildup in their blood vessels and vascular age. After 20 years, the combination therapy group had a vascular age 10.2 years younger than that of the group taking a single statin medication.
The "vascular age" shows how old an individual's blood vessels appear to be based on risk factors and plaque buildup. It can either be lower or higher than an individual's chronological age. For example, in the combination therapy group the vascular age was 74, about 7 years older than the average chronological age. In contrast, the single medication group had a vascular age of 84, or 20 years older than their chronological age.
Phan and his colleagues also critiqued an older study, known as FATS (the Familial Atherosclerosis Treatment Study), that was carried out when lovastatin and other statins were still unproven. Since then, statins have become standard therapy to help achieve lower cholesterol. This study separated patients with extremely high cholesterol into 3 different categories:
- Lovastatin (Mevacor) plus colestipol group
- Colestipol plus niacin group
- The placebo group
During this observational study, one group received one statin and the other group received combination therapy. After 11 years, the combination therapy was changed slightly. By the end of the study, 43 patients in the combination therapy group were still being followed up, as well as 26 patients in the single medication group.
After the study finished, the authors found that the combination therapy group had an LDL level of 85 milligrams per deciliter, while the single medication group had an LDL level of 103 milligrams per deciliter. In addition, the combination therapy group also had higher levels of HDL and lower levels of triglycerides.
The investigators conducted an ultrasound exam to measure fatty build-up in the carotid artery, commonly known as CIMT (carotid intima-media thickness). The CIMT was 17 percent thicker in the single medication group compared to the combination therapy group.
In conclusion, the researchers found the vascular age of the single medication group was much higher than the other group.
"These findings are the first to illustrate the benefits of long-term intensive combination lipid, cholesterol therapy, for 20 years in patients with atherosclerotic disease."
Written by Kelly Fitzgerald