Cholesterol medicines stop artery disease

Rigorous use of drugs that avert heart attacks is examined in study

November 13, 2003|By KNIGHT RIDDER/TRIBUNE

ORLANDO, Fla. - Intensive treatment with a cholesterol-lowering drug over 18 months halted coronary artery disease, according to provocative research presented yesterday.

So-called statin drugs are known to significantly lower heart attacks and deaths, but this study, which compared two of those drugs, used a new type of ultrasound imagery to look into coronary arteries and showed the disease could be stopped in its tracks.

The results suggest that a more aggressive approach to lowering LDL cholesterol (the bad kind) in patients with known coronary artery disease may be in order, said lead author, Steven Nissen, medical director of the Cleveland Clinic Cardiovascular Coordinating Center.

The study was sponsored by Pfizer, the maker of the drug Lipitor. The Lipitor group in the study had a 0.4 percent reduction in artery disease, although the cut was not considered statistically significant.

Pravachol, the other drug in the study, is made by Bristol-Myers Squibb. Treatment with a moderate dose of Pravachol showed a 2.7 percent increase in plaque buildup.

Nissen made news this month when another drug company-sponsored study he led showed that a synthetic HDL cholesterol (the good kind) infused into the arteries of patients reversed artery disease.

Eventually, HDL-raising therapy, plus aggressive LDL lowering, may be the best approach, he said, speaking at the American Heart Association annual meeting yesterday.

"I believe that's the future of cardiovascular disease prevention," he said.

However, several questions about both approaches remain unanswered.

Both studies were relatively small and involved a select group of patients with known heart disease. In addition, the studies used a relatively new type of imagery known as intravascular ultrasound to measure the volume of plaque within the artery walls.

The technology, which was developed in the 1990s, has created a great deal of excitement in cardiology, but it has yet to be proved whether the changes it finds translate into real-life reductions in heart attacks.

"The burning question is, How well does this correlate with clinical events?" said Sidney Smith, a professor of medicine at the University of North Carolina at Chapel Hill.

Smith said the research is important, and if the technology is verified by other studies, it could signal a new era of more aggressive treatment of LDL cholesterol.

Guidelines say people with heart disease or at high risk for heart disease should lower LDL to below 100 milligrams per deciliter. People with at least two risk factors should lower it to 130.

In the new study, which involved 654 patients, the Pravachol group was able to lower LDL to 110. LDL in the Lipitor group was reduced to an average of 79. There also was a 36 percent reduction in C-reactive protein, or CRP, a substance found in the blood that indicates inflammation, which is believed to play a major role in heart disease. People with heart disease generally have elevated CRP.

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