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Is Lower Really Better for Cholesterol?

Study Casts Doubt, Shows High-Dose Drug May Cause Muscle Problems
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WebMD Health News

Sept. 14, 2004 -- In a study of people with heart disease, results show that high doses of the popular cholesterol-lowering drug Zocor may not prevent heart disease deaths and heart attacks -- and may cause muscle damage. But experts say that the new adage of "lower is better" still holds true when it comes to cholesterol.

The study results were presented last month at the European Society of Cardiology Congress 2004 and appear in the new issue of The Journal of the American Medical Association.

High doses of Zocor were associated with increased rates of muscle damage. Nonetheless, study researcher Michael Blazing, MD, said at a news conference at the meeting that doctors should still consider starting treatment at a higher dose and to be more aggressive when prescribing Zocor and other cholesterol-lowering drugs in its class, known as statins. Blazing is with Duke University Medical Center in Durham, N.C.

Asked to clarify that statement, Blazing told WebMD that he and his study colleagues recommend a 40 mg dose, rather than an 80 mg dose of Zocor.

Blazing added that studies of other statins -- notably recent studies of high-dose Lipitor -- suggest that the high-dose statins are both safe and effective.

His study looked at nearly 4,500 patients who had severe chest pain or a heart attack. The researchers were trying to determine if there was any benefit to starting Zocor right away. Half the patients received early aggressive treatment -- 40 mg of Zocor for a month (started within an average of three to four days) followed by 80 mg Zocor -- or conservative treatment with four months of placebo followed by 20 mg of Zocor.

The study did show that early aggressive Zocor treatment appeared to slightly decrease the risk of heart disease death, heart attack, and stroke. However, the study findings were not strong enough to be considered significant. All patients also received other traditional heart disease treatments, including aspirin.

In those treated with placebo first, LDL "bad" cholesterol levels increased by 11% during the initial placebo phase. LDL then decreased 31% from baseline after four months of 20 mg Zocor. However, in those that took Zocor for the entire study, LDL cholesterol decreased by 39% over the first four months. LDL then decreased an additional 6% following the increase to 80 mg of Zocor.

Christopher P. Cannon, MD, associate professor at Harvard Medical School, tells WebMD that "the real message of this study is that it confirms the 'lower is better' message" when it comes to cholesterol.

Cannon, who did not participate in the current study, was principle researcher of a previous study that showed high-dose Lipitor was associated with an approximately 50% reduction in LDL "bad" cholesterol, reducing LDL down to approximately 62 mg/dL. Moreover, aggressive Lipitor treatment reduced the risk of death, heart attack, severe chest pain, or stroke by 16%.

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