Can medication stabilize or reverse vascular disease? And how much should medication reduce cholesterol levels? With lipid lowering how low should you go? Russell H. Samson, MD, FACS, RVT, Clinical Associate Professor Department of Clinical Sciences (Vascular Surgery) at Florida State University Medical School, Sarasota, Florida, addressed these difficult questions today at the 37th annual VEITHsymposium™ held at the Hilton New York (New York, NY).
Dr. Samson said the question regarding whether medication can stabilize or reverse vascular disease, is difficult to answer. Atherosclerosis is a condition in which fatty material collects along the walls of arteries. This fatty material thickens, hardens (forms calcium deposits), and may eventually block the arteries. Cholesterol can’t dissolve in the blood. It has to be transported to and from the cells by carriers called lipoproteins. Low-density lipoprotein, or LDL, is known as “bad” cholesterol. High-density lipoprotein, or HDL, is known as “good” cholesterol
Samson reminded the audience that in general, statin medications can certainly be shown to stabilize atherosclerosis adding that this may be true also for some of the other cholesterol lowering agents such as fibrates and niacin. Reversal, however, is less certain.
Dr. Samson discussed the results of two of many recent studies that warrant further appraisal and said “These are the reversal and asteroid trials. In the reversal trial, patients were treated with intensive lipid lowering therapy with atorvastatin 80 mg or pravastatin 40 mg. The atorvastatin patients had no change in medium plaque volume, whereas the patients on pravastatin had a 2.7% increase in medium plaque volume. Further, some of the atorvastatin patients showed plaque regression.”
Atheromatous plaque reversal has been demonstrated with an experimental drug, Apo 1 Milano. Atheromatous plaques are deposits or degenerative accumulation of lipid-containing plaques on the innermost layer of the wall of an artery.
When infused, Apo 1 Milano resulted in a 4.2% plaque reduction in just five weeks. Currently, a number of pharmaceutical companies are experimenting with versions of medications that can raise HDL with the hope that this can result in plaque regression.
Dr. Samson noted, “The question of how low we should go with lipid lowering agents is even more difficult to answer. There are studies comparing intensive therapy with one statin versus less intensive therapy with another, but that does not answer how low we should go. And there are currently no major studies evaluating different statins to achieve a specific target LDL,” concluded Samson.
Researchers are still questioning whether it is lowering LDL that achieves results. Current ATP III guidelines suggest that in patients at risk, drug therapy should be instituted with a goal of reducing LDL to less than 100 mg/dL with the optional goal being less than 70 mg mg/dL.
Source: VEITHsymposium