“Daily updated tips to lower cholesterol”—– For local cardiologists, the results of last week’s groundbreaking study on heart disease and cholesterol drugs reaffirmed a long, firmly held belief: Lower cholesterol levels can save lives.

“This is a drum that has to be beaten with certain conviction and verve,” said Dr. Bryan Donohue, chief of the Division of Cardiology and medical director of the Cardiac Catheterization Laboratories at UPMC Shadyside.

“For most all of us, the answer is less cholesterol. I think that this latest trend — the pearl in the necklace — makes it clear that a target LDL [low-density lipoprotein or bad cholesterol] at or below 70 is a starting point.”

The study, published in the New England Journal of Medicine, found that apparently healthy patients given the anti-cholesterol drug Crestor (rosuvastatin) suffered 50 percent fewer heart events, including strokes, heart attacks and death, than those on a placebo.

The study involved 17,800 men (50 and older) and women (60 and older) with LDL levels of 108 — a level generally considered to be normal in the United States — and higher-than-normal levels of inflammation as measured by levels of “high-sensitivity C-reactive protein” (CRP) in the blood.

The results showed that Crestor reduced LDL by 50 percent and CRP levels by 37 percent, but it left unclear whether lower cholesterol, lower arterial inflammation, a combination of the two or some unknown factor, prompted the reductions in cardiovascular events.

“Does this mean everyone needs to take expensive medication? That is not what this study means,” said Dr. Daniel Edmundowicz, director of preventive cardiology at UPMC’s Cardiovascular Institute. “What it does mean is that very aggressive lowering of cholesterol is helpful and is more important than how you get it done.”

He said average cholesterol levels in the United States leave people “with plaque smoldering in the arteries.” That helps explain why 41 percent of the population, including many with average cholesterol levels, will die from heart disease. It does prove that American cholesterol levels are too high.”

A healthy total serum cholesterol level of LDL and healthy cholesterol or HDL, is considered to be under 200, with an LDL for most people under 100.

But some local cardiologists say the target for their high-risk patients is a total serum cholesterol level of 110 to 120, with LDL in the range of 50 to 70. Many of those patients already have heart disease or face higher risk from obesity, smoking, hypertension, diabetes or a family history of heart disease.

Based on the study’s results, those unable to reduce their cholesterol levels with diet, exercise and weight loss could face added pressure from doctors to take such statin drugs as Crestor or Lipitor.

Dr. Mark J. Geller, senior cardiologist at West Penn Hospital and clinical assistant professor of medicine at the University of Pittsburgh Medical Center, was a principal investigator in the study but cautioned against reading too much into the findings.

Before deciding on new tests or stricter treatment, doctors must consider all factors involved in heart disease, including diabetes, tobacco, hypertension and family history, “For every test ordered, we’re spending health care dollars, so tests should be ordered thoughtfully,” he said.

Nonetheless he added that anyone with average cholesterol levels but other risk factors above average could benefit from a regimen of statin drugs, he said.

“This reaffirms my sense of being correct and being aggressive,” Dr. Geller said, noting that aggressive control of hypertension and blood sugar also are key. “This may make me more lenient in ordering CRP tests, but I’m already pretty aggressive.”

Doctors could decide to await new guidelines from the American Heart Association and National Institutes of Health.

Dr. Sidney C. Smith, senior adviser for the Cardiovascular Research Translation and Application for the NIH’s National Heart, Lung and Blood Institute, said the study, known as Jupiter, will play an important role in a project already under way to set new cholesterol guidelines for Americans. Those guidelines, expected to be announced late next year or early 2010, must integrate all pertinent factors, including cholesterol levels, obesity and hypertension.

Dr. Robert Vogel, chief medical officer for the Pritikin Longevity Institute and co-chairman of the National Football League’s Committee on Cardiovascular Risk, said the U.S. average total cholesterol level of 206 is twice what it should be.

Before statin drugs are prescribed, people first should change their diet, get adequate exercise and lose weight to reduce cholesterol, he said.

“The other message I give is that although I prescribe statins, you can do a lot with diet and exercise,” Dr. Vogel said. “Not to think about that first is a mistake.”

The most effective way to reduce CRP is by losing weight, he said. The Pritikin diet, for example, will reduce CRP by 40 percent, which was slightly better than what researchers achieved with Crestor.

“It’s an important study but it doesn’t mean the whole U.S. should be on a statin,” Dr. Vogel said. “It does mean that we are more at risk than we thought we were.”

One concern expressed by local cardiologists is the statin drugs’ reputation for producing dangerous side effects. Doctors said statin drugs actually are generally safe, if monitored properly.

But a percentage of people on statins do experience muscle fatigue and a rare few suffer renal failure, among various other side effects. One patient in the Jupiter study who suffered the beginnings of renal failure was removed from Crestor, study results state.

Another study funded by the NIH points to evidence that statins do cause muscle weakness, fatigue and deterioration, said Jill Slade, assistant professor of radiology and osteopathic manipulation medicine at Michigan State University.

Statins prevent cholesterol from forming, but cholesterol is needed to create muscle cells.

In a news release on her research, Dr. Slade said about 50 percent of all Americans over the age of 50 are on statin medications, whose use has tripled in the past seven years.

Side effects affecting muscles and bones have been reported in up to 7 percent of users, though Dr. Slade thinks that number could be higher.

While doctors acknowledge that side effects are possible, they can be reduced or eliminated through monitoring.

“I see relatively few side effects,” said Dr. Michael Campsey, a cardiologist with Frazier-Hart Inc. cardiology practice based in Washington, Pa. “The most common is muscle cramps and weakness.”

But he said there is some paranoia surrounding statin drugs, some of which appears on anti-statin Web sites.

“They’re safe if monitored properly,” he said. “You have to be aware of drug interactions. “Side effects are rare as long as you are paying attention.”

Edited from David Templeton

This entry was posted on Saturday, November 22nd, 2008 at 8:39 am and is filed under lower cholesterol. Tags: American Heart Association, anti-statin Web sites, arterial inflammation, Bryan Donohue, Cardiac Catheterization Laboratories, Crestor, Daniel Edmundowicz, David Templeton, diabetes, dtempleton@post-gazette.com, fatigue, Frazier-Hart Inc., Heart attacks, heart disease, Hypertension, inflammation, Jill Slade, Lipitor, Lung and Blood Institute, Mark J. Geller, Michael Campsey, Michigan State University, muscle cramps, muscle weakness, National Football League, National Football League's Committee on Cardiovascular, National Institute of Health, New England Journal, NIH's National Heart, obesity, osteopathic manipulation, paranoia, Pennsylvania, Pittsburgh Medical Center, Pittsburgh Post, Pritikin Longevity Institute, renal failure, Robert Vogel, Sidney C. Smith, strokes, The New England Journal of Medicine, United States, University of Pittsburgh, UPMC's Cardiovascular Institute, Washington, West Penn Hospital. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.