Giving the cholesterol-lowering drug pravastatin to patients who have suffered a heart attack or who have unstable angina sharply reduces their risk of dying or of having a subsequent heart attack, according to a new study reported last week.
"For the first time ever, cholesterol lowering with pravastatin in the average heart attack patient has been shown to save lives," Dr. Andrew Tonkin of the National Heart Foundation of Australia told a meeting of the American Heart Assn. in Orlando, Fla.
"Not only that," he added, "these patients on pravastatin had fewer [subsequent] heart attacks, less stroke, and less need for heart surgery and angioplasty."
Pravastatin is one of six federally approved drugs--generically named statins--that have been found remarkably effective in reducing heart disease by lowering cholesterol levels.
The LIPID (long-term intervention with pravastatin in ischemic disease) study, directed by Tonkin, involved 9,000 men and women from Australia and New Zealand, with cholesterol levels ranging between 155 and 270 milligrams per deciliter (mg / dl), who had suffered a heart attack or been admitted to a hospital with unstable angina.
In the group that received pravastatin (trade name: Pravachol), there were 23% fewer deaths, 29% fewer heart attacks and 20% fewer strokes. The group also required 24% fewer heart surgeries.
Help for the Healthy: Cholesterol-lowering drugs may even help healthy people with normal levels of cholesterol, according to a second major study presented in Orlando. The so-called AFCAPS / TexCAPS study involved 6,605 patients in their 40s, 50s and 60s enrolled at Lackland Air Force Base in San Antonio and the University of North Texas Health Sciences Center in Fort Worth.
Their average cholesterol level at the beginning of the study was 221 mg / dl, slightly high but in the normal U.S. range. Half received lovastatin (trade name: Mevacor), and half received a placebo. The trial was stopped prematurely this past summer because the say results in the treated group were so much better than those in the placebo group.
Overall, the treatment reduced the risk of sudden death, heart attack and unstable angina by 36%. The treatment was especially effective for women, whose risk fell 54%, compared to 34% for men. In people with either hypertension or diabetes, the risk fell by 43%.
"This extends the benefits to millions of Americans who are not currently considered candidates for cholesterol-lowering therapy," said Dr. Antonio M. Gotto Jr. of Cornell University, who led the study. The treatments, however, cost about $100 per month.
Sexual Turnoff: High blood pressure can be a big turnoff for women, in some cases ruining their sex lives, says Dr. Laurie Duncan of Bassett Healthcare Systems in Cooperstown, N.Y. Men have complained for years that high blood pressure medicine affects their sex lives, but it can dampen the ardor of women, too, she told the heart meeting.
Her team's study of 224 premenopausal white women in upstate New York showed that those with high blood pressure were more likely to experience some sexual dysfunction than women with normal blood pressure.
The most common problem was an inability to lubricate, Duncan said. There were also problems with orgasm and pain during intercourse in hypertensive women, she added.
The reasons are not clear. Perhaps the same thing that causes high blood pressure also caused the dysfunction, she said. Perhaps it was the high blood pressure itself, or maybe it was the medication, diet and exercise used to lower blood pressure.
High-Risk Chores: Normally sedentary men with heart disease and high levels of cholesterol must be especially cautious about undertaking any vigorous physical activity--even mowing the lawn--because it may trigger a sudden heart attack, says Dr. Renu Virmani of the Armed Forces Institute of Pathology in Washington, D.C. Sudden bursts of activity can rupture plaque inside blood vessels, she said, producing obstructions that block blood flow.
Her team examined coronary arteries of 102 sedentary men who died during their normal daily life and 26 who died during strenuous activity, such as moving furniture, mowing the lawn or shoveling snow. Among those who died during exercise, 62% showed evidence of ruptured plaque, compared to only 28% of those who died during normal activities or while resting.
New Approach: Small doses of radiation delivered to coronary arteries after angioplasty can keep the vessels from closing up again and thereby prevent heart attacks, say researchers from Emory University.
About 500,000 Americans annually undergo angioplasty, in which a balloon is inflated inside the artery to compress accumulated plaque and reopen the arteries. But about a third of the arteries become clogged again within a couple of years, necessitating another angioplasty or a bypass.
In the new approach, surgeons use a tiny catheter to temporarily insert a pellet of strontium-90 into the arteries, bathing their walls with beta radiation.
Dr. Spencer B. King III of Emory reported on 35 patients who underwent the procedure. Studies six months after the procedure showed that the diameter of their arteries had not decreased significantly, he told the meeting. A larger trial now underway will evaluate the technique on 1,100 patients at 26 medical centers.