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Heart Patients Can't Always Count on Good Cholesterol Levels

Some who meet the guidelines still suffer progressive coronary disease

WEDNESDAY, June 19, 2002 (HealthDayNews) -- Just because you've reached the recommended cholesterol level guidelines doesn't mean your coronary disease has gotten better -- or even stabilized.

That's the conclusion of researchers who performed positron emission tomography (PET) scans on 57 people with known heart disease. They discovered that one-quarter of the patients still had progressive heart disease, even though their lipid-lowering drugs appeared to be working.

"Simply adhering to the numbers does not in any way guarantee that a patient is not going to have reversal of their coronary disease or even arrest of their coronary disease," says Dr. Michael Merhige, study author and clinical associate professor of nuclear medicine at the State University of New York-Buffalo. "A substantial portion will reverse."

Merhige and his fellow researchers presented their findings yesterday at the Society of Nuclear Medicine's annual meeting in Los Angeles.

Knowing which patients are deteriorating may let cardiologists identify good candidates for more aggressive therapy, the researchers say.

The 57 people surveyed all had coronary disease, and had been taking lipid-lowering medications (which reduce fats in the bloodstream) for an average of three years. PET scans were taken at the beginning of the study and again an average of three years later.

Everyone in the study had reached National Cholesterol Educational Program guidelines for cholesterol levels. "From a public health standpoint, that's what we want everyone to do," Merhige says.

The PET scans, however, revealed a different story.

While 75 percent of the participants had stabilized or reversed their coronary disease, 25 percent were worse (one person in this group actually had a heart attack).

"I would not have thought that the disease in one out of four would have progressed. That was a surprise," Merhige says. The biggest surprise, though, was there was no correlation between improved cholesterol levels and improved PET results.

Which means we can't rely on the numbers, the researchers say.

The findings would seem to provide a powerful argument for incorporating PET scans into the management of heart patients, but the technology may not be ready for prime-time.

"PET imaging has had a stuttering kind of history," says Dr. Stephen Siegel, a clinical assistant professor of medicine at New York University School of Medicine.

"It's been around for a while. It's a little bit different from other kinds of nuclear imaging and, in a lot of ways, it's more expensive and there are questions as to whether it's better," Siegel says. The generator to power the scanner could cost as much as $25,000 a month to operate, he adds.

Merhige says that, when you consider that currently several different tests have to be used, the PET paradigm is "cost-neutral."

Siegel also says he's not as surprised that not all the heart patients in the study stabilized or got better.

"Everything doesn't help everyone all the time," he says. "If all therapy were perfect, nobody would ever get heart disease again, and we know that's not true. We're trying to reduce the rate of progression."

What To Do

For more information on cholesterol and heart disease, visit the National Cholesterol Education Program, or the American Heart Association.

SOURCES: Michael Merhige, M.D., clinical associate professor, nuclear medicine, State University of New York-Buffalo; Stephen Siegel, M.D., clinical assistant professor, medicine, New York University School of Medicine, New York City; June 15-19, 2002, Society of Nuclear Medicine annual meeting, Los Angeles
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