Cholesterol Medication: Are High Doses Better?

Getting tough on cholesterol (search) with high doses of the cholesterol medication Lipitor (search) may help prevent heart attacks.

Researchers found that 80 milligrams of the cholesterol medication Lipitor decreased heart attacks more than the usual treatment of high cholesterol. The study appears in the Nov. 2 issue of the Journal of the American College of Cardiology.

Michael Koren, MD, FACC, of the Jacksonville Center for Clinical Research in Jacksonville, Fla., studied more than 2,400 heart disease patients, all of whom had high cholesterol. Two-thirds of the group were already taking cholesterol medications at the beginning of the study. The study was funded by Parke-Davis and Pfizer Pharmaceuticals. Pfizer is a WebMD sponsor.

Cholesterol guidelines updated in July 2004 call for lowering LDL “bad” cholesterol to less than 70 mg/dL in patients with heart disease. This almost always requires cholesterol medication. The current study was performed before these new guidelines — when the LDL goal in heart disease patients was less than 100 mg/dL.

Participants were divided into two groups. One group took increasingly higher doses of Lipitor until their LDL cholesterol was less than 80 — or they were taking a maximum dose of 80 milligrams of the cholesterol medication. The second group received any treatment, including possible cholesterol medication, deemed appropriate by their regular doctor. The researchers followed the participants’ for more than four years on average.

The high-dose cholesterol medication group appeared to fare better. Their risk of heart disease events – including death, heart attack, and severe chest pain — was reduced by 17 percent compared with people receiving usual-care treatment.

Most of the reduction in heart disease events was due to a drop in nonfatal heart attacks in people receiving high doses of the cholesterol medication. Nonfatal heart attacks occurred in a little more than 4 percent of the high-dose cholesterol medication group, compared with 8 percent of the usual-care group.

The group receiving high doses of the cholesterol medication also had a significantly greater drop inLDL cholesterol (search). Overall, 72 percent of those receiving the cholesterol medication at high doses had an LDL of less than 100 compared with 40 percent of the other group.

There were no significant differences in the rates of fatal heart attacks between those taking high doses of the cholesterol medication and the usual-treatment group.

No additional side effects were seen in the high-dose cholesterol medication group, say the researchers. This is important since researchers have been concerned that higher doses of these cholesterol medications may increase the risk of side effects, such as liver damage.

Lipitor is in the same class of other cholesterol medications, including Crestor (search) and Pravachol (search). Pravachol is already approved to reduce the risk of a heart attack.

By  Miranda Hitti, reviewed by  Michael W. Smith, MD

SOURCES: Koren, M. Journal of the American College of Cardiology, Nov. 2, 2004; vol 44: pp 1772-1779. News release, American College of Cardiology. WebMD Medical Reference from Healthwise: “Evaluating Cholesterol Test Results.” Pfizer, “The Best Get Better — Pfizer Joins Forces with Warner Lambert.”