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Cholesterol Drug Helps After Angioplasty

According to researchers at the Erasmus University Hospital, a common cholesterol fighting drug, a statin called Lescol or fluvastatin, can reduce the risk of heart complications by up to 20 percent for about 1 million American each year. "This reduction in major heart events -- such as dying of heart disease or suffering another heart attack is quite impressive," said Dr. Patrick Serruys,// professor of interventional cardiology at Erasmus University Hospital, Rotterdam, the Netherlands.

Serruys, the principal investigator of the Lescol Intervention Prevention Study or LIPS, and his colleagues recruited 1,022 patients from 55 institutions in Brazil, Canada and Europe who had undergone angioplasties to open clogged coronary arteries. Patients were eligible if they had their first angioplasty procedure within the previous six months.

In an angioplasty, a balloon-tipped catheter is guided by X-rays to the site of a main artery blockage that keeps blood from the heart. The balloon is inflated and crushes the blockage to the side of the artery wall to allow for greater blood flow. The correction rarely is permanent, however.

"More than a million Americans under angioplasty or similar procedures each year," Serruys said. "Although angioplasties are highly effective in the short-term, 2 out of every 5 patients will suffer a heart attack or will need to have bypass surgery or another angioplasty within five years."

In reporting the results of the LIPS trial at the annual meeting of the American College of Cardiology in Atlanta, Serruys said doctors gave patients a placebo or fluvastatin, a proven cholesterol-lowering medication. After about four years of treatment, Serruys found:

* A 22 percent reduction in death, heart attack or requiring another heart procedure, either open heart bypass surgery or another angioplasty.

* Diabetic patients on fluvastatin experienced a 47 percent reduction in the risk of havi ng a serious cardiac event.

* Patients with atherosclerosis or disease in more than one coronary artery who were taking fluvastatin experienced a 34 percent reduction in serious events.

* Patients who were on fluvastatin saw their low density lipoprotein or LDL -- the so-called bad cholesterol -- fall from about 131 milligrams per deciliter at the start of the trial to 99.1 mg/dL.

Dr. Ira Nash, associate director of the Cardiovascular Institute at Mt. Sinai School of Medicine, New York, said getting LDL cholesterol below 100 is one of the goals of the National Cholesterol Education Program. He also said treatment with cholesterol-lowering statin drugs has been shown to have additional benefits to patients aside from lowering cholesterol -- which is known to help reduce heart attack risk.

"This study may get the attention of the interventional cardiologist," said Dr. Roger Blumnethal, a spokesman for the American Heart Association and director of preventive cardiology at Johns Hopkins Univeristy, Baltimore, Md. "Often the interventionalist leaves the prescribing of statin medication to the primary care doctor and sometimes that addition to the patient's regimen falls through the cracks."

Interventional cardiologists most often perform angioplasties. "I think this and other new studies will go a long way in improving the quality of care of all patients with coronary artery disease," he said. Serruys said the researchers used the drug fluvastatin because it has a proven safety record as patients would be expected to continue taking the drugs for many years, possible for a lifetime. He said other statins, including more potent cholesterol-lowering agents, might not have as solid a safety record.

In LIPS, he said there were no indications of any worrisome liver abnormalities or muscle problems seen with other statin drugs. The study was supported by Novartis Pharmaceuticals, Basel, Switzerland, the manufac turer of Lescol.


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