MONDAY, Sept. 23, 2002 (HealthDayNews) -- Aggressive cholesterol-lowering drug treatment, with doses higher than now used, seems to help the arteries a lot, a study finds.
But bigger studies and more conclusive evidence are needed before any changes should be made in current recommendations about the cholesterol-lowering statin medications, experts say.
The study, done at the Walter Reed Army Medical Center in Washington, D.C., included 161 people who were clear candidates for statin therapy because of known cardiovascular disease or other conditions. Some of them were prescribed 40 milligrams a day of the drug pravastatin, and the others took 80 mg a day of a different drug, atorvastatin.
The researchers then monitored their blood levels of LDL cholesterol, the "bad" kind that clogs arteries, and did ultrasound examinations of their carotid arteries, which supply blood to the brain, after six months and a year.
A 12-month blood test showed that LDL cholesterol levels for those taking the lower dose of pravastatin averaged 110 milligrams per deciliter of blood, down 27.5 percent from the initial reading, says a report in tomorrow's issue of Circulation: Journal of the American Heart Association. LDL cholesterol levels for those taking the higher doses of atorvastatin averaged 76 milligrams per deciliter, down 48.5 percent.
Current American Heart Association guidelines say an LDL level of 100 is "optimal," a reading of 130 "borderline high" and 160 or over "high."
The ultrasound studies showed a clear difference in the plaque deposits in the carotid arteries, deposits that could eventually block those arteries. The deposits thinned slightly in the high-dose atorvastatin participants and thickened slightly in the pravastatin participants.
These are encouraging results, says Dr. Allen J. Taylor, director of cardiovascular research at Walter Reed and leader of the study, but they are just the beginning of a process "to construct evidence of what the optimum LDL cholesterol is and take steps to reach it."
"We regard the regression shown in the study to be a good thing," Taylor says of the ultrasound findings. "But this is only a surrogate marker. These data need to be linked to clinical outcome data showing less cardiovascular disease."
The study's results are "of potential interest and could have significant implications," says Dr. Prediman K. Shah, director of the division of cardiology at Cedars-Sinai Medical Center in Los Angeles. But he is as cautious as Taylor about applying them to medical practice just now.
"More in-depth research is needed" to show that lowering LDL cholesterol so aggressively actually will save lives, Shah says.
Large-scale studies looking at the effect of aggressive therapy are under way, but their results are not expected for some time, Shah says.
Taylor finds "a bit of irony" in all these studies, saying that what is already known about cholesterol is being ignored by too many people. "We can make the guidelines or goals more stringent than they are currently, but we overlook the fact that too few patients now are getting proper treatment," he says.
Maybe "optimal" should be redefined, Taylor says. "But a few people might read this and say, 'My reading is 95 and it should be 70,' " he says. "That may be the case, but I'd be much more enthused if someone learns that his LDL is 150 and says that it should be 100. There's a lot more room for improvement."
What To Do
You can learn about recommended LDL cholesterol levels and how to reach them from the American Heart Association or the National Heart, Lung and Blood Institute.
