it might help men with existing heart disease
When it comes to men with coronary artery disease, there may be no such thing as lowering total blood cholesterol levels too far. A study in the current issue of the journal Circulation found that the arteries in male patients with a cholesterol level as low as 155 milligrams per deciliter_a figure many Americans would envy_benefited from cholesterol-lowering medication as much as those with higher levels.
For perspective, the National Cholesterol Education Program’s guidelines for adults recommend that heart disease patients aim for a cholesterol level of about 160 mg/dl. For adults without heart disease, anything below 200 mg/dl is considered desirable. While some research has raised questions about the safety of very low cholesterol levels, no danger has been proved.
The new report fuels an ongoing debate about how aggressively to treat heart disease patients whose cholesterol is already fairly low. Dutch scientists studied 885 men under age 70 with total blood cholesterol levels ranging from 155 mg/dl_lower than patients in other studies of cholesterol-lowering drugs_to 310 mg/dl. All of the men had symptoms such as a previous heart attack or angina pain. After meeting with a dietitian to discuss a lower-fat diet, about half the men received the drug pravastatin and the others got a placebo. Pravastatin, sold in the United States by
Bristol-Myers Squibb as Pravachol, belongs to a class of drugs that includes simvastatin (Zocor) and lovastatin (Mevacor).
Good numbers. After two years, the pravastatin group’s cholesterol levels had improved, while the placebo group’s hadn’t markedly changed. In the pravastatin patients, total cholesterol dropped 20 percent and LDL_or “bad”_cholesterol fell 29 percent. In addition, their HDL_or “good”
cholesterol, thought to have a protective effect_rose 10 percent.
Beyond the numbers, artery-clogging deposits actually shrank in 54 of the men who received the drug, compared with only 30 of those on the placebo. Arteries continued to narrow in 142 of the pravastatin-treated men but 181 of the placebo patients. About an equal number in each group saw no change. Only 20 pravastatin patients needed an unanticipated angioplasty to unclog an artery, compared with 47 in the placebo group.In each of the groups, about two dozen men had to undergo unexpected heart-bypass surgery. Study co-author Albert Bruschke, a cardiologist at the University Hospital Leiden, says he and his collaborators plan to study women next.
Some leading U.S. cardiology researchers note that coronary artery disease is relatively uncommon in people with very low cholesterol levels. In the United States, only about 20 percent of first-time heart-attack patients fall below 200 mg/dl.
But Bruschke points out that even people in China, where a total cholesterol of 155 mg/dl is considered above normal, develop heart disease. Whatever the definition of high cholesterol, Bruschke’s study is one of several that underscore the need to treat it_a message that still hasn’t gotten across to all cardiologists and patients. In that light, observes Scott Grundy, chairman of the American Heart Association’s cholesterol task force: “I don’t think we ought to quibble over exactly what number we should start with.”