Cholesterol: Lower Is Better

(Author By Melissa Tennen) Higher doses of cholesterol-lowering drugs may help lower the risk of heart attacks, chest pain and bypass surgery, says a study in the New England Journal of Medicine.

This is a breakthrough finding that could change the way doctors treat people with heart disease.

“We know getting LDL cholesterol down below 100 is a good way to prevent death and heart attack,” says Christopher P. Cannon, M.D., lead author of the study, associate professor of medicine at Harvard Medical School and a member of the cardiovascular division at Brigham and Women’s Hospital in Boston.

“For the past seven or eight years, the question we have been asking is: Is it even more beneficial to use super-high doses to get cholesterol levels below the current guidelines to prevent a heart attack?”

Yes, says Cannon’s research that looked at more than 4,000 people hospitalized for heart attacks, bypass surgery and chest pain. People in the study were divided into two groups. One got the standard dose of the cholesterol-lowering drug called atorvastatin (Lipitor®) and the other took a high dose of pravastatin (Pravachol®).

Both groups saw decreases in their “bad” cholesterol levels, or low-density lipoprotein (LDL). The standard treatment group dropped LDL levels to 95 milligrams per deciliter while the high dose group lowered LDL to 62 milligrams per deciliter.

That resulted in the high dose group’s risk for death, heart attack, chest pain, angioplasty, bypass surgery or stroke dropping by 16 percent. The higher dose group had a 29 percent reduction in the risk for chest pain and a 14 percent drop in the need for doctors to reopen or bypass clogged arteries.

“Intensive treatment needs to be started right after the hospitalization and not to start at a low dose. If you do that, you have already missed an opportunity to prevent a heart attack,” Cannon says. “A big surprise was how quickly this benefit emerged. The benefits started as soon as they got home from the hospital.”

The National Cholesterol Education Program recommends doctors get their patients with heart disease to lower their LDL levels to 100 milligrams per deciliter or below. Many doctors stop at 100, and don’t push their patients to go lower than that.

Doubts for other groups

Paul Whelton, M.D., wonders if this treatment applies to more moderate risk people, who tend to be a larger population than those who are in the high-risk category. These are people who have risks such as having high blood pressure, smoking and not getting enough exercise but have not had something as severe as a heart attack, for instance.

“If you are at moderate risk and your chance of dying is low, but it’s going to cost you a lot of money in the next 10 to 15 years, is it worth it?” says Whelton, vice president for health sciences and professor of epidemiology and medicine at Tulane University Health Sciences Center in New Orleans. “The extent to which the results apply to ‘well’ people needs further study.”

However, for people with more risk factors and have had chest pains, a heart attack and bypass surgery, this is certainly worth it.

“I think clinicians armed with this information are going to try for more intensive reduction than in the past,” Whelton says.

Cholesterol drugs underused

Fewer than half of people who should be on cholesterol-lowering medications to lower their risk of coronary heart disease actually are on it. Other statins include fluvastatin (Lescol®), lovastatin (Mevacor®), rosuvastatin (Crestor®) and simvastatin (Zocor®). These were not part of the study.

Patients prescribed cholesterol-lowering drugs are also counseled to adopt a healthy lifestyle by eating plenty of fruits and vegetables and getting more exercise.

Cholesterol is a soft, fat-like, waxy substance in the bloodstream and in your body’s cells. Everyone has it. High cholesterol is a major risk for coronary heart disease, which can lead to heart attack.

Your body makes some cholesterol with the rest coming from meats, poultry, fish, eggs, butter, cheese and whole milk. Some processed foods that don’t have animal products may contain saturated fats and trans fats, which cause your body to make more cholesterol.