Statin Drug Good Bet After Heart Attack
Aggressive, High-Dose Cholesterol-Lowering Drug Treatment Benefits Heart Attack Patients
Nov. 15, 2005 -- People who have already had a heart attack benefit from aggressive doses of cholesterol-lowering drugs.
The finding comes from the long-awaited IDEAL study. Terje R. Pedersen, MD, PhD, of Ulleval University Hospital in Oslo, Norway, and colleagues followed 8,888 North European heart attack survivors for five years. It appears in the in the Nov. 16 issue of The Journal of the American Medical Association.
So does an editorial by Christopher P. Cannon, MD, of Brigham and Women's Hospital and Harvard Medical School. The title of the editorial: "The IDEAL Cholesterol: Lower Is Better."
"This is another huge trial that shows the benefit of lowering cholesterol aggressively," Cannon tells WebMD. "For patients with heart disease, the recommendation is, really, to have your LDL, your bad cholesterol, less than 70. And then if you just have risk factors -- high blood pressure, family history of heart disease, or something like that -- the goal should be less than 100."
Extra Cholesterol Lowering, Extra Benefit
Half the patients in the IDEAL study got standard doses (20 milligrams daily) of Zocor, one medication in the family of cholesterol-lowering drugs called statins. The other half took high doses (80 milligrams daily) of Lipitor, another statin.
Standard treatment generally cuts a person's "bad" LDL cholesterol by more than a third -- and also cuts the risk of a second heart attack, heart disease, and death. Smaller trials suggest that more aggressive treatment can cut LDL cholesterol counts in half -- and significantly add to the original benefit.
It was hoped that the IDEAL study would prove that aggressive treatment protected patients from what doctors call "major coronary events" -- death, hospitalization, or resuscitation from a second heart attack or death from heart disease. That didn't exactly happen. Aggressively treated patients were 11% less likely to suffer these events. But this "trend" was not what scientists consider statistically significant -- that is, there was not less than a 5% chance that the finding was a fluke.
However, aggressive treatment dropped patients' bad LDL cholesterol counts by an extra 23 mg/dL over standard treatment to an average 81 mg/dL. And they had a 16% extra lowering of risk of nonfatal heart attacks and other heart-disease risk factors.
A New Day for Statins
"We are now in the era where there is the proven benefit of lowering cardiac events when you lower your cholesterol by 50%," Cannon says. "The current treatments will cut cholesterol in half. And we see there is a huge benefit in that: a 50% reduction in risk for heart attack.
There's even more good news from the IDEAL trial. The extra benefit from high-dose statins came without significant extra risk.
"There has been so much in the press about side effects. But the side effects quoted as liver damage is never actual damage -- it is an abnormal blood test that tells you that you have to change the dose or the kind of statin you take," Cannon says. "That should not be a limitation in chopping your risk of heart attack or death in half. All that said, you do have to monitor for safety and side effects. You definitely have to monitor with a doctor, but it shouldn't hold you back."
Cannon says all heart patients should know their cholesterol numbers. And statin drugs, while powerful, are no substitute for a heart-healthy diet and frequent exercise.
Cannon is a consultant for, and receives grant support from, drug companies that make statin drugs. Statin drug manufacturers are among WebMD's sponsors.