Aggressive cholesterol lowering has benefits: study

In people with type 2 diabetes, intensive drug therapy to significantly lower "bad" LDL cholesterol reduces the thickness of the carotid arteries, the major arteries in the neck that supply oxygen to the brain, research shows.

The beneficial effect on the thickness of the neck arteries is similar in people who attain equivalent LDL cholesterol reductions by taking a statin drug alone or by taking a statin plus another cholesterol medicine called ezetimibe, the researchers found. Ezetimibe (Vytorin) pairs the statin drug Zocor with cholesterol fighter Zetia.

However, the addition of ezetimibe may be required if a statin alone fails to lower LDL levels to target levels, they report in the Journal of the American College of Cardiology.

The Stop Atherosclerosis in Native Diabetics Study, or SANDS, trial, tested the value of aggressively lowering LDL cholesterol to 70 milligrams per deciliter (mg/dL) or lower, and non-HDL cholesterol to 100 mg/dL or lower, versus lowering levels of these harmful lipids merely to "standard goals" (i.e., 100 mg/dL or lower for LDL and less than 130 mg/dL for non-HDL-C).

If the LDL goal was not reached with a statin alone in the aggressive group, ezetimibe was added.

The study involved 427 type 2 diabetic Native Americans who were age 40 or older and who had no history of heart attack or other heart-related event. There were 204 people in the standard treatment group and 223 in the aggressive treatment group - 154 treated with statins alone and 69 who received statin plus ezetimibe.

Ultrasound tests showed that neck artery thickness got worse, or progressed, in the standard treatment group and regressed, to a similar degree, in the two aggressive treatment groups.

Nearly identical proportions of patients in the two aggressive subgroups demonstrated no change or a decrease in neck artery thickness during follow-up, Dr. Wm. James Howard at MedStar Research Institute in Hyattsville, Maryland, and colleagues report.

Comparable LDL and non-HDL cholesterol lowering accomplished with a statin plus ezetimibe versus a statin alone resulted in similar benefit, they say.

Ezetimibe "remains a viable therapeutic option for patients who fail to reach their LDL cholesterol target on a statin alone," they conclude.

SOURCE: Journal of the American College of Cardiology, December 16/23, 2008.