Cholesterol-lowering drugs and coronary artery disease

Cholesterol-lowering medicines work in various ways to lower cholesterol in the blood. There are different types of cholesterol-lowering medicines. Some block the formation of cholesterol. Others help the body remove extra cholesterol, leaving less cholesterol available in the blood to build up in the arteries.

Cholesterol-lowering drugs previously were used only in people who had highcholesterol. Overall, the evidence supports lowering cholesterol as a step that is good for almost everybody (especially people with heart disease and people at risk for heart disease). Cholesterol-lowering medicines can help lower the risk of heart attack, stroke, and death in many people who have average to high cholesterol levels.1, 2 Many studies have found that lowering cholesterol in people at high risk of having a heart attack substantially reduces the risk of death and future heart attack.3

Recent studies and guidelines for statins

Your doctor may prescribe a cholesterol-lowering drug called a statin if you have high cholesterol, signs of heart disease, or risk factors showed that in people with prior unstable angina or non–Q-wave heart attack, a cholesterol-lowering drug (statin) also reduced the chance of developing recurrent chest pain leading to hospitalization.4 A non–Q-wave heart attack usually involves a coronary artery that becomes partially blocked for a long time.

Studies also show that, compared with standard treatment with cholesterol-lowering medicines, aggressive cholesterol-lowering therapy with statins slowed the progression of coronary artery disease.5, 6 In the PROVE IT study, people who recently had episodes of unstable angina or heart attacks received higher-than-standard doses of statins and had fewer subsequent heart attacks, strokes, and deaths. The higher doses resulted in low-density lipoprotein (LDL) levels around 60 milligrams per deciliter (mg/dL). In light of this and other studies, national guidelines now advise doctors to consider more intensive treatment for people at moderate to high risk of heart attack to achieve LDL levels much lower than 100 mg/dL.7

If you have a moderate to high risk, the goal is to lower your LDL 30% to 40% with a statin. Many people who are older than 60 with diabetes, high blood pressure, or high cholesterol are at moderate to high risk of heart attack.

If you have a very high risk, a new optional goal is to lower your LDL below 70 mg/dL. In the TNT trial (Treating to New Targets trial), lowering LDL levels below 100 mg/dL reduced the risk of heart attack and stroke.8 You are considered at very high risk for a heart attack if you have CAD and at least one of the following conditions:

Cholesterol-lowering medicines should be used in addition to making changes in your diet and exercise habits to reduce cholesterol levels.

Citations

  1. Lewis SJ, et al. (1998). Effect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol levels in the average range: Results of the Cholesterol And Recurrent Events (CARE) trial. Annals of Internal Medicine, 129(9): 681–689.
  2. Waters DD, et al. (2002). Effects of atorvastatin on stroke in patients with unstable angina or non–Q-wave myocardial infarction. Circulation, 106(13): 1690–1695.
  3. Gami A (2006). Secondary prevention of ischaemic cardiac events, search date July 2004. Online version of Clinical Evidence (15): 1–31.
  4. Schwartz GG, et al. (2001). Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes. The MIRACL Study: A randomized controlled trial. JAMA, 285(13): 1711–1718.
  5. Cannon CP, et al. (2004). Intensive versus moderate lipid lowering with statins after acute coronary syndromes. New England Journal of Medicine, 350(15): 1495–1504.
  6. Nissen SE, et al. (2004). Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis. JAMA, 291(9): 1071–1080.
  7. Grundy SM, et al. (2004). Implications of recent clinical trials of the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 110(2): 227–239. [Erratum in Circulation, 110(6): 763.]
  8. LaRosa JC, et al. (2005). Intensive lipid lowering with atorvastatin in patients with stable coronary artery disease. New England Journal of Medicine, 352(14):1425-1435.

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