Document Detail

Unresolved issues in early trials of cholesterol lowering.
MedLine Citation:
PMID:  7572687     Owner:  NLM     Status:  MEDLINE    
A reexamination of early intervention trials in patients with coronary artery disease (CAD) shows that a pessimistic view of cholesterol reduction in such patients is inappropriate. In observational studies, individuals with documented coronary artery disease and elevated cholesterol levels fare worse than individuals with normal or low cholesterol levels. Early trials of cholesterol reduction in individuals with coronary artery disease succeeded in lowering total cholesterol levels by only 5-15%. Nevertheless, when reviewed in meta-analysis, these trials demonstrated borderline effects on total mortality, statistically significant benefits in terms of morbidity and mortality due to cardiovascular disease and CAD, and no increase in mortality from noncardiovascular causes. Substantially greater lowering of low density lipoprotein (LDL) levels was achieved in early regression studies. In these studies, examples of improvement were noted in individual coronary artery segments. What was not appreciated initially was the dramatic reduction in coronary events. Older secondary prevention trials did not definitively address the benefits of cholesterol reduction in individuals whose cholesterol levels were only modestly elevated (total cholesterol, 160-240 mg/dl [4.14-6.21 mmol/liter], and LDL cholesterol levels 100-160 mg/dl [2.59-4.14 mmol/liter]). Several other issues were not addressed in these early studies, including the effect of declines in triglyceride levels, increases in high density lipoprotein (HDL) levels, and the effects in women and individuals aged > 60 years. Even with these limitations, a comparison of meta-analyses of other medical interventions--i.e. beta blockade and aspirin therapy--indicates that declines in coronary mortality are in the same range as obtained in older studies with modest cholesterol reduction--i.e., 20-25%.(ABSTRACT TRUNCATED AT 250 WORDS)
J C LaRosa
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The American journal of cardiology     Volume:  76     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1995 Sep 
Date Detail:
Created Date:  1995-10-27     Completed Date:  1995-10-27     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  5C-9C     Citation Subset:  AIM; IM    
Tulane University Medical Center, Office of the Chancellor, New Orleans, Louisiana 70112-2699, USA.
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MeSH Terms
Anticholesteremic Agents / therapeutic use*
Cholesterol, HDL / blood
Cholesterol, LDL / blood
Clinical Trials as Topic
Coronary Artery Disease / etiology
Coronary Disease / drug therapy,  etiology
Hypercholesterolemia / blood,  complications,  drug therapy
Middle Aged
Reg. No./Substance:
0/Anticholesteremic Agents; 0/Cholesterol, HDL; 0/Cholesterol, LDL

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