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Heart smart: Start by lowering cholesterol
Years of research indicate that high cholesterol is a major cause of heart disease. More recent clinical trials show that lowering your LDL or "bad" cholesterol reduces the risk of heart disease. Primary prevention, or making changes before a heart attack strikes, is key, says Dr. Ravinder Kohli, a cardiologist with Cardiology Associates of Central Virginia. "When you reduce your LDL cholesterol by 30 percent, you reduce your risk of heart attack by 30 percent - it is a one-to-one ratio," he defines. What is your risk? "First we need to figure out their level of risk. This dictates and drives how aggressive we need to treat their cholesterol problem," says Dr. Foster Jennings, a cardiologist with Virginia Cardiovascular Specialists. Your primary care doctor can check your cholesterol levels with a blood test. Optimal levels are:
• Triglycerides - lower than 150 • Total cholesterol divided by good cholesterol - less than 5 Next is to assess lifestyle and medical history. Risk factors that affect treatment are: • Diabetes • High blood pressure • Lower "good" cholesterol • Smoking • Family history • Age "The more risk factors for heart disease you add, the more risk there is, the more we need to lower the bad cholesterol," adds Jennings. Diabetics are considered to have the same risk level for heart disease as those who have coronary artery blockage. "We treat both groups of patients very aggressively. The national goal is to get their LDL level under 70," says Jennings. Initially, doctors treat patients with several risk factors with cholesterol-lowering drugs, such as statins. Clinical trials using statins have been remarkably consistent. They reduce the risk of heart attack and death by 25-30 percent, Jennings cites.
New cholesterol-lowering drug emerges Recent news reports have focused on the preliminary results of Merck and Schering- Plough's trial on the cholesterol drug Vytorin. Vytorin is the only marketed drug with two different cholesterol-lowering medications combined. "It's a great combination," says Jennings. "The Zetia decreases the amount of cholesterol that your body absorbs from the food you eat. The Zocor, a statin, reduces the amount of cholesterol that your liver can produce." Targeting the problem with two complementary drugs has been a good strategy for people whose bad cholesterol levels have not decreased enough on statins alone or who cannot tolerate high levels of certain statins because of side effects such as muscle aches and liver problems, Jennings adds. The Vytorin study placed people on either the combination of Zetia/Zocor or Zocor alone. The study revealed that the combination drug Vytorin (Zetia/Zocor) was no more effective in reducing arterial plaque than taking just a statin (Zocor). The people chosen also had a genetic disorder that causes extremely high cholesterol levels - 400 to 500 - compared to the average high cholesterol patients having levels over 200. "These patients are notoriously difficult to treat, and it is hard to reach the targeted cholesterol goals," states Jennings. Additionally, the researchers chose a very technical method to measure plaque growth, Kohli observes. Both doctors agree that with such high cholesterol levels to start, you cannot realistically expect to affect plaque growth in the arteries. The FDA has not taken Vytorin off the market, and the study results have not swayed local doctors either. Jennings published a question and answer sheet for patients. Kohli has been fielding calls from concerned patients. Both have been telling patients to stay on Vytorin. Jennings adds, "The good news is that there were no safety concerns raised in the Vytorin study. Now, between 10 and 20,000 patients are enrolled in Vytorin studies that will give us the answers we really need." |
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