SAN ANTONIO -- Six million healthy Americans not previously considered candidates for cholesterol-lowering treatment could slash their risk of heart problems by a third with drug therapy, researchers say.
But with the cost of treatment as high as $100 per month, the question of who should be treated is likely to be decided by individual doctors and their patients based on additional risk factors, at least until more information is available, experts said.
"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 in San Antonio, the study's principal investigator.
The eight-year Air Force/Texas Coronary Atherosclerosis Prevention Study examined whether lovastatin, sold under the ZTC brand name Mevacor, could reduce heart problems in patients who for the most part weren't candidates for cholesterol-lowering therapy under current guidelines.
The results were published in today's Journal of the American Medical Association. Preliminary findings had been presented in November at a meeting of the American Heart Association, and in March at a meeting of the American College of Cardiology.
The study included 6,605 men and women. The patients enrolled in the study had reduced levels of so-called "good" cholesterol, or HDL, but normal or near-normal levels of "bad" cholesterol, or LDL.
Researchers found the drug reduced by 36 percent the risk of heart problems, including heart attack, new unstable angina and sudden cardiac death, compared with those who received a placebo.
"It's an excellent study, a very important study," said Dr. Sid Smith, a cardiologist and past-president of the American Heart Association.
But in an accompanying editorial, Dr. Thomas Pearson of the University of Rochester School of Medicine argued that the reduced risk of heart problems provided by the drug "may be statistically significant, but not cost-effective in such a low-risk group of patients."
Pearson wrote that patients in the study were treated at a cost of $1,075 to $1,766 per year. The study found that five years of treating 1,000 patients would prevent 12 heart attacks, seven cases of unstable angina and 17 "revascularization" techniques such as coronary bypass surgery and angioplasty.
Pub Date: 5/27/98