Aggressive Lipid Lowering Reverses Atherosclerosis Progression
Family Practice News, Oct 1, 2000 by Bruce Jancin
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AMSTERDAM -- Aggressively lowering LDL cholesterol with high-dose atorvastatin reversed the progression of atherosclerosis in patients with familial hypercholesterolemia, Dr. Tineke Smilde reported at the 22nd Congress of the European Society of Cardiology.
Moderate lowering of LDL cholesterol slowed but did not reverse the atherosclerotic progression, added Dr. Smilde of the University Medical Center, Nijmegen, the Netherlands.
She reported on 325 adults with familial hypercholesterolemia who were randomized to receive 80 mg/day atorvastatin or 40 mg/day simvastatin.
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Results of the trial cannot be used to compare the relative merits of the two cholesterol-lowering drugs, since the study did not include clinically comparable dosages. Rather, the study reflects the difference between aggressive and less aggressive therapy
Patients were followed with serial measurements of carotid intimal medial thickness in the double-blind Dutch Atorvastatin vs. Simvastatin on Atherosclerosis Progression (ASAP) trial. Patients were 48 years of age, on average, and had a mean baseline LDL cholesterol level of 310 mg/ dL, a reflection of the extraordinarily high LDL levels that are typical of the familial disorder.
Carotid intimal medial thickness, a well-established predictor of coronary risk, averaged 0.93 mm at baseline. In normal individuals, this thickness averages 0.5-0.7 mm. After 2 years of statin therapy the mean intimal medial thickness had decreased by 0.031 mm in the atorvastatin group and had increased by 0.036 mm in the simvastatin group.
More than two-thirds of atorvastatin-treated patients experienced a decrease in carotid intimal medial thickness.
Blogger Comment:
Reversal of astherosclerosis requires aggressive lipid lowering, moderate dosing may slow the progression and even may not affected particularly those with severely high LDL. As a general role the lower the better for LDL provided the patient can tolerate the drug. How low to go with LDL is still debatable. In the future low LDL of 50-60 may become the role for most men over 40 and women over 50 years old, remain to be seen.
