BOSTON -- A new study showing that aggressive use of cholesterol-lowering drugs can reverse serious heart disease could have an immediate impact on the treatment of millions of patients with severe chest pains and other symptoms, doctors say.
The study, published today in the New England Journal of Medicine, showed that combinations of lovastatin and colestipol, or niacin and colestipol, reopened clogged coronary arteries and dramatically cut the risk of complications in many patients.
"We actually saw the disease melt away," said Dr. Greg Brown of the University of Washington Medical School and lead author of the study. He had presented some of the findings at an American Heart Association scientific meeting last November.
Doctors familiar with the research said it could have implications for the more than 300,000 people a year who have coronary bypass surgery and for the more than 40 million Americans with high cholesterol but no disease symptoms.
Earlier studies had suggested that lowering cholesterol could help patients with heart disease, but some physicians "have still been hesitant to treat aggressively," said Dr. Joseph Loscalzo of Harvard Medical School, who wrote an accompanying editorial.
The study "lends all the more strength to the argument that we have to be more aggressive," Loscalzo said. "It really is a landmark study."
Brown's study examined the effects of the drugs in people who had high levels of low-density lipoprotein, the "bad" cholesterol, as well as definite signs of blocked coronary arteries and a family history of the disease.
"These results apply directly to something on the order of 3 million people in the United States with established heart disease and a high level of the particular type of cholesterol we measured," Brown said.
If the fivefold increase in prescriptions for cholesterol-lowering drugs from 1983 to 1988 is any indication, it appears that doctors already have begun taking some of the advice to heart. A study in April in the Journal of the American Medical Association found that nearly 13 million prescriptions were filled in 1988, largely because of the introduction of two drugs at the time, gemfibrozil and lovastatin.
Every year in the United States, more than 500,000 people die from heart disease, the leading cause of death in America.
The study reports that patients undergoing the aggressive treatment had 73 percent less chance of chest pains or blockages that required bypass surgery or angioplasty.
Dr. Daniel Steinberg, who headed a 1984 scientific panel that strongly recommended that Americans reduce their cholesterol, said the need for bypass operations could shrink if the drugs are used to reverse or prevent seriously clogged arteries.