In an editorial published in the Journal of the
American Medical Association online March 13,
cardiologists at Johns Hopkins embrace results of a study
that shows aggressive use of a cholesterol-lowering drug,
rosuvastatin (Crestor), significantly reverses
atherosclerosis and its potentially fatal risks.
According to the American Heart Association, nearly
three-quarters of all deaths from cardiovascular disease
are due to atherosclerosis, a condition marked by a
long-term deposit of fat and calcium plaques in arteries
that nourish the heart.
Left untreated, the hardening and narrowing of these
vessels create a high risk that blood flow to the heart
will be compromised or clots will break off and trigger a
stroke.
In the two-year study, conducted at the Cleveland
Clinic and other institutions, more than 500 men and women
with mild to moderate atherosclerosis were given the
maximum approved dose of 40 milligrams per day of the
statin drug, which lowers levels of cholesterol and other
fats in the blood. Using ultrasound imaging to measure the
degree to which arteries were clogged both before and after
treatment, plus blood chemistry testing, researchers found
that patients experienced an average 53 percent decline in
the so-called bad cholesterol, or LDL, to just over 60
milligrams per deciliter of blood. They also found that HDL
cholesterol levels, the so-called good cholesterol that
keeps arteries clear, increased on average by 15 percent,
to an average 49 milligrams per deciliter of blood. Overall
disease progression was slowed by an average of 14 percent,
as measured on a disease-specific scale known as percent
atheroma volume, with no significant adverse drug
effects.
"The study results are very exciting and bound to stir
debate and further research," said cardiologist Roger S.
Blumenthal, an associate professor and director of the
Ciccarone Preventive Cardiology Center at the Johns
Hopkins School of Medicine and its
Heart Institute and lead author of the editorial.
"Until now, many scientists did not believe that
atherosclerosis could be reversed, even modestly, in
people."
Blumenthal cautions that the study's results would
have been more convincing if the authors had compared the
intense cholesterol-lowering treatment to a more moderate
treatment, such as simvastatin (Zocor), another statin
drug, which has been shown in large clinical trials to be
very effective in reducing cholesterol levels.
He says a definitive answer to why the dramatic
reduction in cholesterol leads to the benefits observed in
this study will not be ready until results are released
from other ongoing clinical trials that are comparing the
effects of different dosages and levels of statin
treatments.
Editorial co-author Navin K. Kapur, a clinical
research fellow at Johns Hopkins, added that "researchers'
next steps have to determine whether these very promising
results translate into greater reductions in future heart
attacks and strokes."
The new research, which appears in the same issue of
JAMA, will be simultaneously presented by other scientists
at the annual scientific sessions of the American College
of Cardiology taking place March 11 to 14 in Atlanta.
Results are part of a longer-term study to evaluate the
effect of rosuvastatin on intravascular ultrasound-derived
coronary atheroma burden, called ASTEROID.
"The results certainly support the idea that we should
be even more aggressive in our cholesterol management of
people with at least moderate atherosclerosis," Blumenthal
said. It would be reasonable, he said, for doctors to aim
for lowering bad cholesterol levels to below 70 milligrams
per deciliter in people with at least moderate narrowing of
the coronary arteries. This objective, he pointed out, was
listed as an optional target in the last update of the
National Cholesterol Program Guidelines for people with
diabetes and heart disease who had a recent episode of
angina, where they experienced chest pain due to decreased
blood flow.
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