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| By Marie Cheine, Medical Writer On November 12, 2003, at the American Heart Association Meeting in Orlando, Florida, Dr. Steve Nissen, Medical Director of the Cleveland Clinic Cardiovascular Coordinating Center and Principal Investigator of the REVERSAL study announced that patients taking Pfizer's cholesterol-lowering medicine Lipitor® (atorvastatin calcium) experienced a significant reduction in the progression of atherosclerosis, or hardening of the arteries, compared to patients who received Bristol-Myers Squibb’s Pravachol® (pravastatin). It is not new news to must that atherosclerosis is a leading cause of death from heart attack and stroke. This occurs when there is a build up of fatty areas in blood vessels called plaques. These plaques can break up and disperse in the blood vessels, causing blocked blood flow which can be fatal. Within the body, many fats travel from place to place in the blood as passengers in lipoproteins. HDL and LDL are two of these lipoproteins and are commonly called “good cholesterol” and “bad cholesterol.” Both HDL and LDL carry lipids in the blood. LDL lipoproteins are larger, lighter and carry more lipids. HDL lipoproteins are smaller and carry more protein. The job of LDL in the body is to carry triglycerides and cholesterol from the liver to the tissues. In contrast, the job of HDL is to collect excess cholesterol and lipids from the tissues for disposal. For this reason, LDL cholesterol has been nicknames the “bad cholesterol” even though LDL and HDL carry the same cholesterol. Elevated LDL levels in the blood forecast coronary disease. According to the American Heart Association LDL cholesterol of less than 100 mg/dL is the optimal level. Less than 130 mg/dL is near optimal for most people. A high LDL level (more than 160 mg/dL or 130 mg/dL or above if you have two or more risk factors for cardiovascular disease) reflects an increased risk of heart disease (http://www.americanheart.org/presenter.jhtml?identifier=180). The REVERSAL study followed 502 patients with coronary artery disease who required cardiac catheterization or angiograms and compared the effectiveness of Lipitor® versus Pravachol® in reducing plaque build-up. According to Dr. Nissen in an article in the New York Times on November 13, 2003, after 18 months of study, patients taking Lipitor® had no change in the plaque in their arteries, but those taking Pravachol® had a 2.7% increase in plaque. Julie Keenan, a spokeswoman for Bristol-Myers Squibb, in the same NY Times article, stated, “While these results are informative, additional studies will be needed to assess whether different statins would cause disparate reductions in clinical outcomes.” The study raises difficult questions, particularly in view of the fact that new, more aggressive drugs for lowering cholesterol are becoming available. According to Christie Ballantyne, M.D., a cardiologist at Baylor College of Medicine, we can reduce LDL by 50% routinely. Her question is, “ . . . is it O.K.? What will that mean in terms of costs of drugs, side effects of drugs, prevention of heart attacks?” One thing that has come out of this study is for certain. The war on heart disease will continue at full force. |
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