Cholesterol lowering helps even heart patients with healthy levels

Tuesday, November 13th 2001, 12:00 am
By: News On 6

ANAHEIM, Calif. (AP) _ Even heart patients with seemingly healthy cholesterol levels live longer and better if they take cholesterol-lowering drugs, a discovery that could vastly increase the number of people using these already ubiquitous medicines.

The findings emerge from the largest experiment ever to test the power of so-called statin drugs, which already are recommended for about 36 million Americans at risk of dying from heart disease.

Dr. Rory Collins of Oxford University, who directed the study, compared the results Tuesday with the landmark discovery in the 1980s of the benefits of aspirin in warding off heart trouble.

``Statins are the new aspirin,'' Collins said. ``But it's not either-or. They add to the benefits of aspirin.''

The study was conducted on 20,536 people who were considered at high risk of heart disease. Earlier research had not settled whether they specifically benefit from statin therapy.

One-third of the patients in the study had cholesterol levels that were already below the level recommended for statin treatment in the latest U.S. health guidelines. Yet they, like everyone else in the study, lowered their risk of new heart attacks and strokes by one-third if they took the drugs.

``This means that anybody who has any evidence of heart disease should be on a statin,'' commented Dr. Antonio Gotto, dean of Cornell University's medical school.

About 25 million people worldwide already take statins. Collins estimated that the latest findings mean about 200 million worldwide would benefit from the drugs, roughly double the number for whom they are currently recommended.

The 5 1/2-year study involved men and women ages 40 to 80. They were considered at high risk because of diabetes, previous heart attacks and other signs of clogged arteries, such as poor circulation in their legs.

The study was the first to include substantial numbers of diabetics with no outward signs of heart trouble, as well as women and people over age 70.

Besides lowering the risk of heart attacks and strokes by one-third, the study found that statins also reduced the need for arterial surgery, balloon angioplasty and amputations.

The researchers calculated that if an additional 10 million high-risk people went on statins, that would save 50,000 lives a year. They estimated that for every 1,000 people treated for five years, statins would prevent heart attacks and strokes in:

_ 100 people who previously have had a heart attack.

_ 80 people with chest pain or other evidence of coronary heart disease.

_ 70 people with diabetes.

_ 70 people who have survived a stroke.

_ 70 people who have had blocked arteries in the legs.

The study, conducted at 69 British hospitals, cost $32 million. It was financed by England's Medical Research Council, the British Heart Foundation, Merck & Co. and Roche Vitamins Ltd. The results were released at a meeting of the American Heart Association.

Guidelines issued last May by the U.S. National Cholesterol Education Program recommend statin treatment for heart disease patients whose levels of LDL, the bad cholesterol, are above 130. For levels between 100 and 130, the guidelines say treatment is at the doctor's discretion.

In this study, 33 percent of the patients had LDL cholesterol below 116.

Over the past decade, a series of large studies has progressively broadened the population of people who might benefit from statin treatment, from heart attack victims with high cholesterol to people with much less ominous outlooks.

The latest study ``is likely to have a major impact,'' said Dr. Harlan Krumholz of Yale University. ``It may simplify our approach to patients.''

Several doctors said they will be more aggressive in offering statins to heart patients even if their levels already seem safe.

``I'll approach my patients with even greater conviction that, if they have heart disease, they will benefit from statin therapy,'' said Dr. Sidney Smith, the heart association's medical director.

The statin used in the study was Merck's Zocor. However, Collins said he believes that all brands of statins are effective.

The study found no evidence that vitamins are good for the heart, an idea already discounted by some previous studies. Half of those studied also took daily beta carotene plus vitamins E and C.