The first head-to-head comparison of two popular statin drugs suggests that lowering cholesterol more aggressively than national guidelines recommend can completely stop dangerous clogging of arteries.
The results address one of the biggest questions in cardiology: How low should bad cholesterol go? The answer seems to be: as low as possible.
Nevertheless, other experts caution that it is too soon to rewrite federal guidelines, although that may be in the offing as several new studies in the next few years tackle this issue.
The latest study compared the two statin pills Lipitor and Pravachol. It found that Lipitor did a considerably better job of both lowering cholesterol and controlling the insidious buildup of plaque inside arteries when given to people with serious heart disease.
Exactly why, though, is unclear. The benefit could not be explained in full by the lower cholesterol levels. Researchers wondered if some other property of Lipitor, such as its stronger effect on inflammation, accounted for its more potent effects.
The study was sponsored by Liptor's maker, Pfizer. Another, larger study is nearing completion, sponsored by Bristol-Myers Squibb, which makes Pravachol.
Doctors have long debated how much heart patients should lower their cholesterol. Guidelines recommend getting LDL, the bad cholesterol, down to 100. But many have wondered whether lower is better.
The latest study lowered that target to 80 and found that the more rigorous treatment seemed to put a halt to artery clogging.
"There is no such thing as too low an LDL. That's what the data seem to show," said Dr. Steven Nissen of the Cleveland Clinic. He gave the results Wednesday at a meeting of the American Heart Assn. in Orlando.
The study involved 654 adults with LDL over 125 who had had symptoms of coronary disease. They were randomly assigned to get either 40 milligrams of Pravachol or 80 milligrams of Lipitor. After 18 months of follow-up, average LDL was 110 in the Pravachol patients and 79 in those on Lipitor.