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Cholesterol Drugs Keep Arteries Open

Statins reduce problems after angioplasty

TUESDAY, June 25, 2002 (HealthDayNews) -- A cholesterol-lowering statin drug can help heart patients who have artery-opening procedures even if they have normal blood cholesterol levels.

The incidence of heart attacks and other major cardiac events was more than 20 percent lower in patients who got a statin after their arteries were widened by balloon angioplasty than for patients who didn't get the drug, says a Dutch study appearing in tomorrow's issue of the Journal of the American Medical Association.

"The data will have lasting implications on the treatment of the post-PCI patient population," says Dr. Patrick W. J. C. Serruys, a professor of interventional cardiology at Erasmus Medical Center in Rotterdam and leader of the study.

PCI means percutaneous coronary intervention, medical talk for procedures that include bypass surgery and balloon angioplasty, in which a balloon is threaded into a clogged artery and opened to improve blood flow. An estimated 1.8 million PCI procedures are done every year, and the number is increasing by 8 percent annually.

The 1,677 patients in the study all had heart problems such as unstable angina, but their blood cholesterol readings averaged 134, only slightly above the level regarded as dangerous. Some were given fluvastatin, one of many statins now on the market, within two days after having a PCI, while others got a placebo.

Over the next 3.9 years, 21.4 percent of the fluvastatin patients had a major cardiac event, including a problem serious enough to require another artery-opening procedure, compared to 26.7 percent of the placebo patients, a 22 percent reduction, the researchers report.

The reduction was even better in high-risk patients: It was 47 percent lower for those with diabetes, and 34 percent lower for those with two or more blocked arteries.

One possible explanation for the result is that "if you are a heart patient, you may be unusually sensitive to cholesterol, so any reduction, even from apparently low levels, may have benefits," Serruys says. The reading for the placebo patients remained around the 130 level, while it dropped to 100 for those who got the statin.

Another possibility is that statins have a protective effect beyond that of lowering cholesterol, he says. "Other mechanisms of action have not been identified, but there are indications that there might be an improvement of endothelial function, through reduction of inflammation," Serruys says.

The endothelium is the delicate tissue that lines the arteries, and a number of studies have indicated that endothelial inflammation contributes to heart disease, he notes.

However, Dr. Michael Davidson, director of preventive cardiology at Rush Medical Center and an advisor to the study, says the cholesterol-lowering effect itself is highly beneficial.

"What we're realizing now is that angioplasty only deals with one part of the artery," Davidson says. "This study suggests that a cholesterol level of 100 is better than 130."

The study was funded by Novartis Pharma AG, which makes fluvastatin under the brand name Lescol. Other statins will have the same effect as fluvastatin, Davidson says, and the practice of giving statins to patients who have artery-opening procedures will be "not just common, but mandatory."

What To Do

You can get a briefing on statins from the National Heart, Lung and Blood Institute. The American Heart Association has more about angioplasty and bypass surgery.

SOURCES: Patrick W. J. C. Serruys, M.D., Ph.D., professor, interventional cardiology, Erasmus Medical Center, Rotterdam, The Netherlands; Michael Davidson, M.D., director, preventive cardiology, Rush Medical Center, Chicago; June 26, 2002, Journal of the American Medical Association
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