Taking very high doses of a drug to push cholesterol to very low levels can help people with heart disease avoid strokes and heart attacks, research has revealed.
But it can also cause liver problems that limit the ability to tolerate such intensive treatment.
A large international study tested this approach for the first time in people with clogged arteries that occasionally cause chest pain, and found that it cut their chances of having a bad event such as a heart attack by 22% compared with those on a lower dose.
The findings “confirm and extend” evidence that this strategy works, concluded the researchers, who were led by Dr John LaRosa of State University of New York.
Results were presented today at an American College of Cardiology meeting in Orlando, Florida.
The study was funded by and involved many doctors with ties to pharmaceutical giant Pfizer, the maker of Lipitor. It is one of six so-called statin drugs on the market that lower LDL or ”bad” cholesterol.
In the study, 10,001 patients in 14 countries took either 10 milligrams or 80 milligrams of Lipitor, bringing their LDL levels to 101 and 77, respectively.
After nearly five years, 10.9% of those on the low dose had died or suffered a stroke, heart attack or other big problem compared with 8.7% on the high dose - an absolute difference of 2.2%, which translated to a 22% reduction in risk.
“This is falling into line with what we saw from other trials” involving different types of patients – those who had recently suffered a heart attack, said Dr Sidney Smith, an American Heart Association spokesman and cardiology chief at the University of North Carolina.
He has been a consultant for Pfizer and other statin makers and also helped draft the federal cholesterol guidelines.
But side effects were a concern. About 1.2% developed sigs of liver inflammation on the high dose versus 0.2% of the others. Patients would have to be aggressively tested and monitored for this condition, Smith said.
Results also might vary with a different statin, he said. Other brands are Bristol-Myers Squibb’s Pravachol, Novartis Pharmaceuticals’ Lescol, AstraZeneca’s Crestor, and Zocor and Mevacor, sold by Merck.