His Healthy Heart

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Lower Cholesterol Counts

When it comes to the "bad" LDL cholesterol, can you go too low? The answer appears to be no. Currently, guidelines call for LDL cholesterol to be less than 100 mg/dL. But a March study led by Steven Nissen, MD, a cardiologist at the Cleveland Clinic, in Ohio, suggests that intensive treatment with a statin drug that reduced LDL even lower than the recommendation had a significant benefit.

In examining more than 500 patients with coronary artery disease, Dr. Nissen and colleagues found that the men (and women) who took a high 80-milligram dose of Lipitor (considered an intensive cholesterol-lowering regimen) reduced their LDL to an average of 79 mg/dL, while those taking 40 mg of Pravachol (considered a moderate cholesterol-lowering regimen) had levels that averaged 110 mg/dL. A subsequent study of 4,000 patients sponsored by the makers of Pravachol came up with similar results: Within a month, the patients taking Lipitor had significantly lower risk of heart attack, bypass surgery, angioplasty, and death than patients taking Pravachol.

"This is a stunning change of direction," says Dr. Nissen. "Of the 36 million Americans eligible for treatment, only 11 million are actually receiving statin drugs, let alone the maximum dosage. It means we have to get physicians to be much more aggressive." How low should you go? That's still under investigation, but researchers are talking about an LDL of 60 or less. Men, however, shouldn't pop pills in lieu of lifestyle changes. "If you smoke, stop. It's deadly," Dr. Nissen says. "If you have high blood pressure, get it treated. And, women, if you want your husbands to live longer, get them off the couch and on an exercise program."

Continued on page 4:  Exercise Is the Best Medicine


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