DALLAS, April 21 -- Do individuals gain progressive benefits in heart attack protection as the drugs, called statins, take cholesterol levels to "new lows?" This is the topic of three reports and an editorial appearing in today's Circulation: Journal of the American Heart Association.
"An important question is how much additional benefit do individuals who have had a heart attack get from reducing their low-density lipoprotein, (LDL), or 'bad' cholesterol levels from low to very low levels, (below the recommended 100 milligrams/deciliter)? Is it considerable, small amounts or none?" asks Scott M. Grundy, M.D., Ph.D., who wrote an accompanying editorial in Circulation. He is director of the center for human nutrition at the University of Texas Southwestern Medical Center in Dallas.
In one report researchers found that the benefits of the popular statin drugs -- shown to sharply reduce heart attack risk in individuals with elevated blood levels of cholesterol -- taper off, indicating a "threshold" effect when LDL reaches 125 mg/dL, according to Frank M. Sacks, M.D., associate professor of medicine, and other researchers at Brigham and Women's Hospital and Harvard Medical School, Boston.
Another report in the same issue however suggested continued benefit down to a level of 100 mg/dL, although there was some lessening of benefit as LDL approached the lower levels.
Even though the data suggest that there may be attenuation in the benefit of
cholesterol lowering below 125 mg/dL, Grundy stresses that these reports should not be taken as the final word on the issue. "For the present, the guidelines by the National Cholesterol Education Program (NCEP), endorsed by the American Heart Association, offer the most reliable basis for physicians' decisions regardless of the optimal lower limit for LDL cholesterol," says Grundy. A new statin trial, the Treating to New Target (TNT) study, should provide the answers concerning lower limit of benefit, but
Contact: Carole Bullock
American Heart Association