Atorvastatin clears existing plaque

The first study to compare two powerful cholesterol-lowering drugs in coronary artery disease finds that one appears to be superior. Cholesterol drug atorvastatin slightly reduced the build-up of plaque in arteries in the first clinical trial of its kind, as reported by researchers. The clinical trial results were presented at an annual meeting of the American Heart Association. The cardiologist at the Cleveland Clinic directed the study of 502 patients. At the study's start, the middle-aged, mostly male heart disease patients in the study had levels of low density lipoproteins, or L.D.L. (the "bad" cholesterol), of 150, on average. L.D.L. carries cholesterol to arteries. Atorvastatin lowered participants' L.D.L. levels to 79, while those taking pravastatin had an average level of 110. After 18 months, the atorvastatin patients had no change in the plaque in their arteries. Atorvastatin halted progression of plaque and cleared 0.4 percent of existing build-up among patients with clogged arteries. But plaque increased by 2.7 percent in pravastatin patients. The study did not assess patient outcomes like heart attacks and deaths, which would have required 8,000 patients and taken five or more years. In patients taking pravastatin, atherosclerosis worsened slowly over 18 months. But the disease was halted in those who took the highest dose of atorvastatin.

The study assessed the progression of atherosclerosis (disease of blood vessels characterised by deposition of fat on the inside of the walls of large to medium-sized arteries making them hard and brittle and prone to blockage) using a tiny ultrasound camera that was threaded into coronary arteries, allowing researchers to look directly at the growth of plaque. Large studies are under way seeking to determine if more growth, as detected by the ultrasound camera, means more heart attacks and deaths, but many cardiologists predict that it does. Pravastatin patients in the study whose L.D.L. levels fell below 100 still had plaque growth while atorvastatin patients with those L.D.L. levels did not. While several drugs on the market stop new plaque or atherosclerosis from building up, no drug on the market has been proven to both stop new build-up and substantially clear existing plaque.

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