Statins, Lifestyle Changes Cut Artery Plaque

Therapy would benefit those prone to heart disease

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HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

MONDAY, June 9, 2003 (HealthDayNews) -- Taking cholesterol-lowering drugs and making healthy lifestyle changes can reduce dangerous plaque in heart arteries by a third.

That's the conclusion of research presented June 8 at the American Heart Association's Second Asia Pacific Scientific Forum in Honolulu.

The study researchers verified the plaque reduction during a 12-year span with the use of electron beam CT scans. These special types of CT scans take rapid pictures of the heart to determine levels of calcium deposits on cholesterol plaque in the arteries. This can lead to artery blockages and heart attacks.

"This test provides us with the ability to track plaque over time and to demonstrate that lifestyle modification does impart a benefit by reducing atherosclerosis or plaque," Dr. Matthew Budoff says.

Budoff is director of the Electron Beam CT Laboratory at the Research and Education Institute at Harbor-UCLA Medical Center in Torrance, Calif., and a co-author of the study.

He and Dr. Victor Goh, a consultant cardiologist at the Electron Beam Center at Matilda International Hospital in Hong Kong, followed 102 people at high risk for heart disease, performing EBT scans at the beginning of the study in 1990 and then again in 2001 and 2002.

All patients were prescribed statins -- such as Lipitor or Zocor -- to lower cholesterol, and instructed to eat better, exercise more and control their weight.

At the second scan, 33 patients had reductions in their calcification scores, and these were patients who hadn't slacked off on lifestyle changes and medication use, Budoff says. "The majority of the 69 other patients had a small increase and a minority had a significant increase," says Budoff. "The results are quite dramatic."

Overall, the average increase in scores was 24 percent a year, but those who stuck with both medicine and lifestyle changes had an average increase of 16.4 percent.

The researchers also tracked the patients for heart disease problems and found only one patient had had a heart attack, and it was not fatal. There were two strokes and no deaths.

The message, says Budoff, is that "it's very important to maintain the therapy [statin use and lifestyle changes] because there is a long-term benefit as we showed in our study."

EBT scans are available in university hospitals and major medical centers and cost about $400. The 10-minute scan is a modified, open-air CT scan. A patient lies, clothed, on a couch-like device that slides into a tube-shaped scanner. Electron beams bounce around and create heart images.

"It's a very fast CT scan," Budoff says. "Because the heart is moving you need a very fast scan."

While other studies have found similar effects, Goh says the new study is unique because of the follow-up time and the number of patients scanned.

Another heart expert says the EBT scan might motivate those who need to lower their cholesterol to continue taking their medicine, or to begin the drug regimen.

"I have a lot of patients who are resistant to [beginning] medication," says Dr. Raluca Arimie, an interventional cardiologist at the Santa Monica-UCLA Medical Center, in Santa Monica, Calif.

Some people worry about side effects, which can include elevations in liver enzymes and muscle soreness, she says. In the new study, eight patients had liver enzyme elevations, but most were able to resume therapy following an adjusted dose of the statins.

"When someone has a family history or other risk factors for coronary artery disease, he or she should have an EBT scan whenever this can be arranged," Goh says.

More information

For more on electron beam CT, check with the American Heart Association or the University of Iowa.

SOURCES: Victor Goh, M.D., consultant cardiologist, Electron Beam Center, Matilda International Hospital, Hong Kong; Matthew Budoff, M.D., F.A.C.C., director, Electron Beam CT Laboratory, Research and Education Institute, Harbor-UCLA Medical Center, Torrance, Calif., Raluca Arimie, M.D., interventional cardiologist, Santa Monica-UCLA Medical Center, Santa Monica, Calif.; June 8, 2003, presentation, Second Asia Pacific Scientific Forum, American Heart Association, Honolulu

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