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Saturday, June 27, 2009

The lower, the better

For some time now, I have been very aggressive with lowering my patients LDLs to <70mg/dL with statins. The evidence has shown multiple times that patients with the lowest LDLs have the lowest event rates.

Patients and their families always ask me will lowering my cholesterol end up shrinking or reducing the extent of blockages in my heart, leg, or neck arteries. My answer is maybe. There is evidence that using Crestor, researchers were able to document a small amount of plaque regression with very low LDLs. I tell my patients that more important than plaque regression is plaque stabilization. Unstable plaques crack and lead to acute events (heart attacks and strokes).

A new study recently presented at the Society for Vascular Surgery 2009 Vascular Annual Meeting reported that after twelve months of Lipitor therapy, patients with LDL levels < 70 had significantly more carotid plaque stabilization that patients with LDLs 70-100.\

This is important for a few reasons:
  1. It seems that ability of statins to stabilize a plaque is not compound dependent but class dependent. (ie: its not which statin you use, but is the statin you are using lowering your LDL below 70)
  2. Plaque stabilization does occur and probably explains why patients with very low LDLs have the lowest event rates

1 comment:

  1. I had read that there were more deaths from the use of statins than from the actual disease itself. Meaning have you or your peers ever considered diet for yuour patients first and then see if that shows results? Just wondering.I had read the results of the Dr Ornish lifestyle changes and they were pretty remarkable but are Drs of the opinion (and is it true) that for most people taking a pill(no matter what the cnsequences) is preferable to retraining bad eating habits and lazy beings:)
    Besides some people have familial problems that no amount of dieting will change their status?