Cholesterol-lowering drugs may work as well as heart surgery
July 7, 1999
Web posted at: 5:10 p.m. EDT (2110 GMT)
From Medical Correspondent Dr. Steve Salvatore
(CNN) -- Heart disease is the leading cause of death in the United States. One of the most powerful weapons against heart disease is a powerful class of cholesterol-lowering drugs called "statins."
Statins are so powerful a study in this week's New England Journal of Medicine suggests that in low-risk patients, aggressive cholesterol-lowering therapy with a statin drug called Lipitor is at least as effective as angioplasty in reducing episodes of low blood flow to the heart.
Low blood flow can result in chest pain and heart attack. Angioplasty is a procedure where doctors place a catheter into the heart and use a balloon to open blocked coronary arteries.
Researchers looked at 314 people with coronary heart disease who were considered to be at low risk because they did not have severe symptoms like chest pain.
Of those, 164 were treated with 80 milligrams of Lipitor per day, and 177 underwent the angioplasty followed by the usual care, which could include a cholesterol-lowering treatment.
"Those who were treated with medication had fewer hospitalizations over an 18-month period than those who received angioplasty," said Dr. W. Virgil Brown of Emory University.
Twenty-two percent of those who received the statin therapy had an ischemic event as compared to 37 percent of the patients who underwent angioplasty. Ischemic events included death from heart attack, stroke, coronary artery bypass grafting, angioplasty and worsening chest pains.
The study was done as part of the clinical trial Atorvastatin vs. Revascularization Treatments (AVERT) and was funded by Lipitor maker Parke-Davis, a division of Warner-Lambert.
Doctors caution the findings do not mean statins should be chosen over angioplasty.
"If you are a patient with coronary disease and your doctor recommends a procedure like angioplasty, or a stent or bypass, make sure the doctor recommends right after that a statin to help lower your cholesterol," said Dr. David Vorchheimer, Mount Sinai Hospital.
Lower cholesterol is key, and many people can't do it with diet alone.
"Diet is the first treatment, but then the doctor needs to remeasure the cholesterol and the LDL (bad cholesterol), and if it's still above 100, they should be given medication to bring it below 100," said Brown.
Doctors say many patients are not getting these lifesaving medications.
"Unfortunately we know in the United States that many, many patients who have blockages in their arteries don't really ever get a cholesterol-lowering drug. That was true in this study as well," Vorchheimer said.
Doctors say they can't overemphasize the importance of cholesterol-lowering drugs. Medical research proves statins save lives.
Angioplasty can help open an existing blockage, but lowering cholesterol plays a critical part in preventing blockages from forming in the first place.
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Half of men, third of women will develop coronary heart disease, study finds
January 7, 1999
New England Journal of Medicine
Mount Sinai Hospital
American Heart Association
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