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.