NEW YORK - For decades, doctors have known that patients with lower cholesterol do better than patients with high cholesterol following a heart attack. What hasn't been known is whether using drugs to achieve specific levels of cholesterol made a difference. New research changes that.
A study released Monday may change the way doctors treat patients with heart attacks or severe chest pain. Dr. Chris Cannon of Brigham and Women's Hospital presented the findings at a meeting of the American Heart Association.
"We see benefits of taking cholesterol levels that are low to very low in the post-heart attack patients," said Cannon.
More than 18,000 patients who had either a heart attack or chest pain were treated. Half received a high dose of the statin Zocor and half received Vytorin, which combines a statin with another drug that decreases cholesterol absorption. The statin alone lowered the bad cholesterol - or LDL - to an average of 69. Vytorin dropped it to an average of 54. After seven years, the Vytorin group had 6.4 percent fewer cardiovascular events such as death, heart attack, and stroke
"We found we could prevent two heart attacks or strokes for every hundred patients treated," Cannon said.
One year ago, new cardiology guidelines from the American Heart Association and the American College of Cardiology suggested doctors stop targeting specific LDL levels because there was no good evidence one low level was better than another.
Dr. Steve Nissen of the Cleveland Clinic believes those recommendations need to be changed immediately.
"This study really does blow up the guidelines," said Nissen. "The guidelines didn't have target level for LDL cholesterol and many of us thought that was wrong, and now within a year of issuing the guidelines, we know that that's wrong.
This study was sponsored by Merck, the company that makes Vytorin. What needs more research is whether lowering cholesterol levels with other drugs would be just as effective.
In this case, two drugs were better than one, but a single more powerful medication may do just as well.