A new, important study out of Harvard Medical School this week shows that if you want to avoid a heart attack, you should be lowering your cholesterol even further than what has previously been recommended. Specifically, the study showed that an LDL of 53 was modestly better than an LDL of 70 at preventing a heart attack.
At least one leading Cardiologist, out of Cleveland Clinic, Dr. Steven Nissen, chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic, said he thinks the guidelines should now be updated to say “get as low as you can without an adverse impact on patients.
“Dr. Christopher Cannon, who led the research, said the study shows that patients and doctors need to continue focusing on lowering cholesterol.
“This reminds us that the cholesterol story is true and that lowering cholesterol reduces heart disease,” said Cannon, a cardiologist at Brigham and Women’s Hospital and professor at Harvard Medical School, both in Boston
“The past is littered with trials that adding anything to statins is not effective,” said Dr. Patrick O’Gara, president of the American College of Cardiology and Cannon’s colleague at Brigham and Women’s and Harvard. Niacin, for instance, was long combined with statins because it helped raise levels of “good” or HDL cholesterol, but research last year showed that those numerical improvements failed to translate into fewer heart attacks and strokes.
The IMPROVE-IT results suggest that some combination treatments might be effective. Specifically, in this study, the drug Zetia was shown to add additional benefit.
Should you go on Zetia now? The answer is “depends”. Dr. Patrick O’Gara said, he would consider putting his patients on Vytorin if they couldn’t manage a full dose of statins. Another consideration is that Vytorin is expensive. A 30-day supply costs more than $200 at Costco. Atorvastatin, or generic Lipitor, runs $20 or less, depending on the dose. In the opinion of Evolve Direct Primary Care, one should maximize their Lipitor or similar statin dose first and only if not at a goal LDL of close to 50, then add Zetia.
What is the degree of impact? In relative terms, Vytorin reduced the chances of a heart attack or stroke by 6.4 percent over seven years. As for side effects, they were about the same for both groups.
How big was the trial? The IMPROVE-IT trial was huge — more than 18,000 patients. And it was expensive. “The exact costs of a trial like IMPROVE-IT are difficult to calculate but are on the order of hundreds of millions of dollars,” a Merck spokeswoman said in an email to Shots, as reported on NPR.org.
Part of the importance of LDL is demonstrated in the infographic below. LDL levels are rising. PLEASE–if you haven’t recently, get your lipid profile checked!