Popular Statin Drug Reduces Signs of Heart Disease

March 13, 2006 — -- Dr. Christopher Cannon, a cardiologist at Brigham and Women's Hospital in Boston, said that his patients often ask him if there is anything they can do to shrink the blockages in their heart arteries.

"Until now, the answer was no, but now for the first time we can say yes," he said.

Cannon was referring to a new study released today that shows Crestor, one of the popular statin drugs that lowers cholesterol, could actually shrink plaque that builds up in heart arteries. This finding has implications for millions of Americans who suffer from coronary artery disease, although it's too early for the research to lead to immediate changes in treatment guidelines.

What is the difference between Crestor and other commonly used statins, such as Lipitor and Zocor? "The difference is the potency," Cannon said. Forty milligrams of Crestor works better at lowering LDL, or "bad" cholesterol, than 80 milligrams of Lipitor. The study also found that taking Crestor significantly increases HDL, or "good" cholesterol, a finding that was not seen with other statins.

With Crestor, though, the most telling difference was the changes in the plaque that lined the heart's arteries; plaque lining the areteries was previously thought to be an irreversible cause of heart disease.

Using ultrasound, the researchers measured the size of the plaque before and after two years of high-dose Crestor therapy. They found reductions in plaque buildup, also known as atherosclerosis, in 64 percent of the 500 patients in the study.

Atherosclerosis has conventionally been viewed as a progressive disease, for which even the most effective therapies merely slow its advancement.

Doctors Welcome New Findings

Many cardiologists are enthusiatic about the Crestor results.

"We finally have well-tolerated tools in our toolbox, such as Crestor, to drive cholesterol levels safely into the physiologic range," said Dr. Daniel Edmundowicz, director of preventive cardiology at the University of Pittsburgh Medical Center.

The results certainly appear promising, but some primary care doctors have reservations.

"Less plaque does not necessarily mean longer life," said Dr. Mark Ebell, an internist at Michigan State University.

Many physicians want to see long-term benefits beyond reducing artery plaque, results that translate into fewer heart attacks, strokes and longer life.

But experts agree that high-risk patients -- those with diabetes or known heart disease -- could benefit greatly from Crestor's aggressive LDL lowering.

"The main implications of this study are that we should be aggressively reducing LDL levels in patients with established heart disease, probably well below the 'optional' target of 70 and potentially into the sub-60 range," said Dr. Dan Rader, director of the preventive cardiology and lipid clinic at the University of Pennsylvania.

Not Ready for Prime Time

The goal of statin therapy is to lower LDL to a target level tied to one's overall risk of heart disease. Currently, the recommendation is to maintain LDL below 160 for people who have zero or one risk factor, below 130 for those with two or more risk factors, and below 100 for those with known heart disease or diabetes.

Risk factors include high blood pressure, cigarette smoking, low HDL, age greater than 45 for men or 55 for women, and a family history of premature heart disease.

Most people know that lowering your cholesterol is a good thing, but how low should you go? Is lower always better?

Not necessarily, according to Dr. Lee Green, a family medicine doctor at the University of Michigan.

"At this point, the only evidence that lower is better is for high-risk diabetes patients and people with recent coronary events. Beyond that it's extrapolation," he said.

Although the study's researchers said that Crestor's "adverse events were infrequent and similar to other statin trials," there is concern that Crestor, when taken in high doses, has a less-favorable safety profile than that of other statins.

"It was actually banned in Canada for a while," said Ebell.

Patients on any statin need to watch out for muscle pain, and report it to their doctors immediately if they begin to experience it.

Ultimately, more research needs to be done to determine the long-term benefits of statin drugs. The study was not randomized and did not include a comparison group.

The take-home message: Crestor may benefit high-risk patients with diabetes or known heart disease, but the general population should hold off.

According to Green, high-dose Crestor is "not ready for prime time."