November 10, 2010

How Low Should Your LDL Go?

Posted in New Heart Studies tagged , , , , , , , , , , , , at 12:56 am by keepyourhearthealthy

An example of a heart attack, which can occur ...

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Over the past 10 to 20 years, there has been much debate over how low a person’s cholesterol should go.  The latest study is suggesting we should go even lower than the lowest recommended number so we can prevent more heart attacks.

Several years ago, the guidelines for cholesterol treatment in patients with heart disease changed.  For quite some time, the recommendation had been to treat LDL to less than 100.  The guidelines were then changed to allow cardiologists the “option” of more aggressive treatment to less than 70.  Many studies have proven that higher doses of statins results in lower LDL and fewer heart attacks.

Researchers in the UK and Australia say that we should now consider lowering LDL to less than 50 based on their new research.  They reviewed 26 different trials and found a 22% risk reduction in major vascular events (ie. heart attacks and strokes) when patients were given high dose statins and treated to lower LDL numbers.  Their report also showed that lowering LDL to less than 50 was safe for people at high risk of cardiovascular events.

One of the other points the researchers discussed in their report includes which statins are best to use.  Predictably, the more expensive statins are the most potent such as Lipitor and Crestor (hence, you get what you pay for!).  The researchers discourage the use of the weak statins such as Pravachol (pravastatin) or Zocor (simvastatin).  They did mention that Zocor and Pravachol might be used together for better results but most cardiologists shy away from prescribing 2 statins at the same time.  This method is highly unlikely to happen anytime soon.

Overall, this study brings up the question one more time of how low we should be treating LDL in heart patients.

In some cardiology practices, they may be very conservative in their use of potent statins.  These types of cardiologists will probably resist any changes to the current guidelines.  Other cardiology practices may welcome a lower LDL target so they can give more appropriate, potent statin therapy to the patients at greatest risk.  Patients in general do not like increases in statins due to the possible side effect of muscle aches.  However, if more patients understand the significant benefits of drugs like Lipitor and Zocor they are more likely to tolerate the changes.  It will be interesting to see what, if any, changes this new study will bring about in the near future.

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