Heart patients gain from steep cholesterol drop

Heart patients can lessen their risk of a heart attack and increase their odds of survival by aggressively reducing harmful low-density lipoprotein (LDL) cholesterol in their blood, a new study shows.

Researchers identified 4,162 men and women who had just had a heart attack or severe chest pain. The scientists randomly assigned half the volunteers to get the standard dose of the anticholesterol drug pravastatin or an elevated dose of the more potent statin drug atorvastatin.

The drugs go by the trade names Pravachol and Lipitor, respectively. The study didn’t evaluate the effect of higher-than-normal doses of pravastatin. About two-thirds of the patients in each group subsequently underwent procedures to improve flow in their coronary arteries.

Patients entered the study with an average LDL concentration of 106 milligrams per deciliter of blood. The high dose of atorvastatin pushed that down to an average 62 mg/dl, whereas the standard dose of pravastatin reduced it to 95 mg/dl, on average, the researchers will report in the April 8 New England Journal of Medicine. The recommended LDL concentration for such heart patients is under 100 mg/dl.

Aggressively lowering LDL paid dividends. The likelihood of a heart attack or death due to other heart problems for the next 2 years was 16 percent less in people getting atorvastatin, report Christopher P. Cannon of Brigham and Women’s Hospital and Harvard Medical School in Boston and his colleagues.

Heart patients would benefit from this prompt lowering of LDL beyond currently targeted levels, the authors conclude.