Study Finds High Statin Doses Can Ease Mild Heart Disease
Using high doses of statin drugs to lower cholesterol levels below government guidelines can cut the risk of heart attacks and strokes by 22% in people with moderate heart disease, according to a study released Tuesday.
The study, which involved 10,000 patients, is one of several in the last year that are driving down what doctors consider an optimal level of cholesterol in patients with clogged arteries.
Under government guidelines announced last summer, people with moderate heart disease should be treated to lower their low-density lipoprotein, or LDL -- known as bad cholesterol -- to 100 milligrams per deciliter. Patients at high risk are advised to reduce that number to 70.
The study suggests that patients with moderate risk also should lower their LDL cholesterol to 70 or below.
Such a change in the guidelines probably would lead to millions more prescriptions being written for statins, which are among the best-selling drugs in the world. Even without an official change, doctors said, the study is likely to spur more aggressive use of statins, which inhibit the body’s production of LDL.
“Lower is better,” said Dr. Antonio Gotto, dean of Cornell University’s Weill Medical College and one of the study authors.
The study, presented at a meeting of the American College of Cardiology in Orlando, Fla., tested the Pfizer drug Lipitor in two groups of patients who had clogged arteries but were not at imminent risk of heart attacks. The study was paid for by Pfizer.
Patients taking 10 milligrams a day achieved an average LDL level of 101. Those taking 80 milligrams achieved an average level of 77. The patients were tracked an average of nearly five years.
Though the death rate in both groups was roughly the same, the 22% reduction in heart attacks and strokes among those taking the higher dose of Lipitor provided a strong message to physicians.
“Some doctors will jump on this immediately” and start aiming for an LDL target of 70 in all heart patients, said Dr. Steven Nissen, a cholesterol expert at the Cleveland Clinic Foundation who wasn’t involved in the study.
Two similar studies are being conducted in Europe. The National Institutes of Health, which issues the guidelines for the treatment of heart disease, is likely to wait for the completion of those studies before considering a change.
One concern is whether long-term use of statins can damage muscles and the liver.
One statin, Baycol, was pulled from the market in 2001 after it was linked to a toxic muscle degeneration. Three of the most common statins -- Lipitor, Pravachol and Zocor -- were shown to be relatively safe in a study published last year.
Some patients in the new study were taken off the drug after tests showed abnormal liver function, but the researchers said the risk was low and far outweighed by the benefits.
Dr. Bruce Psaty, an epidemiologist at the University of Washington, said that placing patients on the higher dose would require close monitoring of liver function.