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New Study Suggests Cholesterol Drugs Should Be Started Sooner

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WebMD Health News
Reviewed by Gary D. Vogin, MD

Nov. 15, 2000 (New Orleans) -- For people who have mild heart attacks or severe, disabling chest pain caused by heart disease, the powerful, cholesterol-lowering drugs called statins may reduce the risk of heart attack or death if the drugs are started within four days of hospital admission for heart symptoms.

Currently, statins are given to most people who have what is called "acute coronary syndrome," but the therapy isn't started until several weeks or months after the patient is discharged from the hospital. Heart experts have theorized that giving the drugs earlier could potentially save lives. Researchers tested this theory and found that the drug Lipitor cut the risk of death, heart attack, or worsening chest pain by 16%, compared to patients who got a placebo. The study results were released Wednesday at a meeting of the American Heart Association.

Gregory G. Schwartz, MD, PhD, who presented the results of the study, says that Lipitor also reduced chest pain by 26% and cut stroke by 50%, a result the researchers had not anticipated.

The findings are impressive enough for several members of the adult treatment committee of the National Cholesterol Education Program (NCEP) to say that it's likely that guidelines now being revised will be changed to urge doctors to start giving statins to patients upon diagnosing heart-related chest pain or heart attack. Russell Luepker, MD, of the School of Public Health at the University of Minnesota in Minneapolis, tells WebMD that this means prescribing the drugs even though a patient's blood test for cholesterol may be in the normal range.

The trial involved more than 3,000 patients who were hospitalized after experiencing severe chest pain or a small heart attack. Half of the patients were given atorvastatin and advised to modify their diet, while the other half received a placebo and the same diet recommendations. The patients, whose average age was 65, were followed for 16 weeks.

In addition to initiating therapy early, the MIRACL trial used a "high, aggressive dose of [Lipitor] -- 80 mg," Schwartz tells WebMD.

According to Luepker, who was not involved in the study, that is a very high dose. "I'm not sure we need a dose that high," he says. Because atorvastatin is considered the most potent of the statin drugs, it is often given at lower doses, he says.

"I think we will probably find that we don't need a dose that is quite that high," Valentin Fuster, MD, PhD, tells WebMD. Fuster, director of the cardiovascular institute at Mount Sinai Medical Center in New York and former president of the American Heart Association, also is a member of the NCEP guideline committee.

Fuster says he thinks that when statins are given right after an "acute event," they are able to reduce the formation of blood clots, which often cause heart attack. He says that this effect is independent of the drug's ability to lower cholesterol.

Pfizer, maker of Lipitor, funded the study.

 

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Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL. The HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is Very High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL because the HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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