Patients whose low-density lipoprotein (LDL) (or bad) cholesterol levels do not respond to cholesterol-lowering statin drugs may have more artery blockages than those whose cholesterol levels drop with treatment, a recent study has shown. The study was led by Professor Steve Nicholls, Heart Health Theme Leader at the South Australian Health and Medical Research Institute (SAHMRI) and Professor of Cardiology at the University of Adelaide.
The results were published last week in in the American Heart Association journal,Arteriosclerosis, Thrombosis and Vascular Biology. The study showed that 1 in 5 patients treated with a statin have minimal lowering of LDL cholesterol, which can clog arteries and increase the risk of heart attack or stroke. Researchers analysed data from seven clinical studies on 647 patients with diagnosed coronary artery disease (CAD) who were prescribed statin drugs to help lower cholesterol. The studies compared diseased arteries before and after statin treatment. The study showed that LDL cholesterol levels had either decreased (minimally), stayed the same or increased in 20 per cent of patients. They had more plaque build up in their arteries than patients who responded to statin therapy.
Professor Nicholls said that a lot of this is likely to be driven by using a suboptimal statin dose, but it also shows that other cholesterol lowering approaches to complement statin therapy in patients may be required. “Monitoring cholesterol levels is vital, in addition to maximising statin therapy,” Professor Nicholls added.
“The potential use of other lipid lowering agents can then be considered. “Ultimately, there are other LDL-lowering therapies undergoing evaluation in clinical trials, which may be particularly useful here. “We will continue to do research to understand how statins work, how to more effectively use established therapies in clinical practice and to develop and evaluate novel approaches to cholesterol lowering that will complement statin therapy,” he said.
Co-authors are Yu Kataoka, M.D.; Julie St. John, M.S.; Kathy Wolski, M.P.H.; Kiyoko Uno, M.D., Ph.D.; Rishi Puri, M.B.B.S.; E. Murat Tuzcu, M.D.; and Steven E. Nissen, M.D. Author disclosures are on the manuscript.