CARDIAC CARE: Study Touts Effectiveness Of Lovastatin

      Healthy individuals with normal cholesterol levels could still benefit from cholesterol-lowering treatments, according to a study published in today's Journal of the American Medical Association. The San Antonio Express-News reports that the eight-year Air Force/Texas Coronary Atherosclerosis Prevention Study "examined whether lovastatin, sold under the brand name Mevacor, could reduce heart problems in patients who, for the most part, weren't candidates for cholesterol-lowering therapy under current guidelines" (Finley, 5/27). The study found that those who took lovastatin had 37% fewer heart attacks and other heart problems such as unstable angina than those who received a placebo (University of North Texas Health Science Center release, 5/26). "This study provides a piece of evidence to clinicians that they didn't have before, because we studied a patient population that was different than any one that was studied in the past," said Lt. Col. J.R. Downs of Wilford Hall Medical Center, the principal investigator of the study (Express-News, 5/27).

Methods And Findings
      The researchers recruited 6,605 men and women between 45 and 73 years of age who had reduced levels of HDL ("good cholesterol") but normal levels of LDL ("bad cholesterol") with three objectives in mind -- "to investigate whether long-term lipid lowering with lovastatin would decrease the rate of first acute major coronary events compared with placebo" to see if it "would decrease cardiovascular morbidity and mortality across the spectrum of clinical events" and "to investigate safety, that is whether long-term treatment with lovastatin, compared with placebo, would result in similar rates of total mortality." Final results found that lovastatin reduced the risk of first heart attacks by 40%, heart procedures, such as angioplasty and bypass surgery by 33%, and unstable angina or chest pain by 32% (Downs et al, JAMA, 5/27 issue). Preliminary results of the study were presented at the annual scientific meeting of the American Heart Association last November. "It's an excellent study, a very important study," said Dr. Sid Smith, a cardiologist and former president of the American Heart Association. "It's exactly the type of study we've needed to move forward with some of our efforts in prevention from an evidence-based standpoint," he said. (Express-News, 5/27).

Cost-Effective?
      In accompanying editorial in today's JAMA issue, Dr. Thomas Pearson of the University of Rochester School of Medicine in New York, writes, "The authors indicate that five years of lovastatin treatment in 1000 individuals would prevent 12 myocardial infarctions" (heart attacks) at a cost between $1,075 per year and $1,766 per year depending on lovastatin dosage. Noting the costs, Pearson writes that although "the overall intervention may be statistically significant," it is "not cost-effective in such a low-risk group of patients" (JAMA, 5/27 issue). Dr. Edwin Whitney, a cardiologist with the Heart and Vascular Institute of Texas and one of the study organizers, "noted that it would be more cost-effective for a patient to put the cost of the drug in the bank and let it build interest over 20 years." He said, "Then, when I have my heart attack or need bypass surgery, I could take it out of the bank and probably have some money left over" (Express-News, 5/27). Dr. Alan Garber, director of the Center for Primary Care and Outcomes Research at Stanford University, said, "'One thing is certain' about statins. 'This is a very expensive way to prevent heart disease'" (Kolata, New York Times, 5/27).