Cholesterol-lowering drugs and coronary artery disease
Cholesterol-lowering medicines work in various ways to lower cholesterol in the blood. There are different types of cholesterol-lowering medicines. Some block the formation of cholesterol. Others block the absorption of cholesterol in the gut or help the body remove extra cholesterol, leaving less cholesterol available in the blood to build up in the arteries.
Cholesterol-lowering drugs previously were used only in people who had high cholesterol. Overall, the evidence supports lowering cholesterol as a step that is good for almost everybody (especially people with heart disease and people at risk for heart disease). Cholesterol-lowering medicines can help lower the risk of heart attack, stroke, and death in many people who have average to high cholesterol levels.1, 2 Many studies have found that lowering cholesterol in people at high risk of having a heart attack substantially reduces the risk of death and future heart attack.3
Recent studies and guidelines for statins
Your doctor may prescribe a cholesterol-lowering drug called a statin if you have high cholesterol, signs of heart disease, or risk factors showed that in people with prior unstable angina or non–Q-wave heart attack, a cholesterol-lowering drug (statin) also reduced the chance of developing recurrent chest pain leading to hospitalization.4 A non–Q-wave heart attack usually involves a coronary artery that becomes partially blocked for a long time.
Studies also show that, compared with standard treatment with cholesterol-lowering medicines, aggressive cholesterol-lowering therapy with statins slowed the progression of coronary artery disease.5, 6 In the PROVE IT study, people who recently had episodes of unstable angina or heart attacks received higher-than-standard doses of statins and had fewer subsequent heart attacks, strokes, and deaths. The higher doses resulted in low-density lipoprotein (LDL) levels around 1.5 millimoles per litre (mmol/L) or 60 milligrams per decilitre (mg/dL). In light of this and other studies, guidelines now advise doctors to consider more intensive treatment for people at moderate to high risk of heart attack to achieve LDL levels much lower than 2.6 mmol/L (100 mg/dL).7, 8
If you have a low to intermediate risk, the goal is to lower your LDL by at least 40% with a statin. Many people who are older than 60 with diabetes, high blood pressure, or high cholesterol are at moderate to high risk of heart attack.
If you have high risk, the goal is to lower your LDL below 2.0 mmol/L (80 mg/dL), or reduce LDL levels by at least 50%.8 In the TNT trial (Treating to New Targets trial), lowering LDL levels below 2.6 mmol/L (100 mg/dL) reduced the risk of heart attack and stroke.9 You may be considered at high risk for a heart attack if you have CAD and at least one of the following conditions:
Cholesterol-lowering medicines should be used in addition to making changes in your diet and exercise habits to reduce cholesterol levels.
| Author: | Douglas Dana Robin Parks, MS | Last Updated: September 21, 2007 |
| Medical Review: | Anne C. Poinier, MD - Internal Medicine Caroline S. Rhoads, MD - Internal Medicine Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology Robert A. Kloner, MD, PhD - Cardiology Ruth Schneider, MPH, RD - Diet and Nutrition | |
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