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Prevention of Atherosclerosis -

It's not Just About Lowering Cholesterol

Hector Fontanet, M.D., FACC

with Marie Cheine, Medical Writer 

June 23, 2005

It is not new news that atherosclerosis is a leading cause of death from heart attack and stroke. This occurs

when there is an excess of cholesterol that builds up fatty areas in blood vessels called plaques. These

plaques can break up and cause blood clots in the blood vessels, causing sudden interruption of flow to the

heart (heart attack), which can be fatal. Lowering cholesterol levels (the cholesterol your body manufacturers

as opposed to dietary cholesterol) has long been known to reduce the risk of cardiovascular events. But it is

not just about lowering cholesterol, but about prevention of heart attacks and stroke and prevention of damage

and inflammation to the lining of the blood vessels.

The medical community has been treating elevated cholesterol levels with a class of drugs known as

statins for over 25 years. Statins have proven to be effective in slowing the progression of plaque build up

in the blood vessels. In early 2004, results from the multi-national trial (PROVE IT – TIMI 22) demonstrated that

lowering a patient’s LDL or “bad” cholesterol to less than 70 mg per deciliter helped prevent recurrent heart

attack and death, even in patients with normal cholesterol levels.

That is why in the recent years the medical community has been examining the relationship between

cardiac events and inflammation. Inflammation occurs in the body in response to infection and injury.

Current views are that exposure to high cholesterol is responsible for inflammation of the blood vessel

linings, resulting in plaque build up and disease progression.

The results of PROVIE IT-TIMI 22 and other major clinical trials found that intensive treatment with statins

also lowers C-reactive protein (CRP), a marker of inflammation in the body. A decrease in levels of CRP

correlated with significantly slower rates of progression of coronary disease. In fact, in a recent study published

in the New England Journal of Medicine, Dr. Nissen and associates showed that patients with the l

argest reductions in CRP levels actually had regression of plaque build-up in the blood vessels (www.nejm.org). 

Furthermore, achieving a target CRP level of <2 mg/l is associated with better outcomes

(less risk of heart attacks and strokes) for patients regardless of the DL level achieved with statin treatment.

These recent studies provide strong evidence that inflammation plays an important role in heart and

vascular disease. Furthermore, the reduction of inflammation after a myocardial infarction may improve

cardiovascular outcomes and alter the atherosclerotic process.

In summary, statin therapy is a widely used drug that is successful in lowering LDL cholesterol and

CRP levels in the blood stream. Large-scale clinical trials have shown the overwhelming

positive results of statin therapy in patients who have suffered a heart attack.

As a class, these medications are safe for most. However, in a small percentage of people, the drugs

can cause muscle pain or fatigue and can affect liver function. Careful monitoring while on statin therapy

is imperative and side effects are easily detected. The benefits of this class of drugs far outweigh the risks.

Recent findings that statins have a dual benefit of reducing LDL cholesterol and CRP levels suggests

that aggressive statin treatment results in the best outcomes for patients.

Source:    New England Journal of Medicine

                American Heart Association