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A 1997 study, the Air Force/Texas Coronary Atherosclerosis Prevention Study, showed that Mevacor helped prevent a first heart attack or unstable angina in men and women with average cholesterol levels but with below-average HDL.

Statins work by interfering with the cholesterol-producing mechanisms of the liver and by increasing the capacity of the liver to remove cholesterol from circulating blood. Statins can lower LDL cholesterol by as much as 60 percent, depending on the drug and dosage.

Heart patient Norbert Hoffmann, 65, of Northfield, Minn., saw what he calls "a dramatic drop" in cholesterol levels after taking Zocor for three months. For example, his total cholesterol went from 270 to 145 mg/dL and LDL from 182 to 82 mg/dL.

But patients can respond differently to drugs. Some patients may have fewer side effects with one drug than another. "I had problems such as stomach cramps with Zocor," says Oklahoma patient Linden Gilbert, 50. His doctor ultimately switched him to Lipitor, which he credits with lowering his total cholesterol from 230 to 150 mg/dL.

Other Drug Treatments

These include:

Nicotinic acid (niacin)-This lowers total and LDL cholesterol and raises HDL cholesterol. It also can lower triglycerides. Because the dose needed for treatment is about 100 times more than the Recommended Daily Allowance for niacin and thus can potentially be toxic, the drug must be taken under a doctor's care.

Resins — Doctors have been prescribing Questran (cholestyramine) and Colestid (colestipol) for about 20 years. These "resins" bind bile acids in the intestine and prevent their recycling through the liver. Because the liver needs cholesterol to make bile, it increases its uptake of cholesterol from the blood.

Fibric acid derivatives — Used mainly to lower triglycerides, Lopid (gemfibrozil) and Tricor (fenofibrate) can also increase HDL levels.

Aspirin — Because studies have shown that aspirin can have a protective effect against heart attacks in patients with clogged blood vessels, doctors often prescribe the drug to patients with heart disease.

The decision of which drug to prescribe is one the doctor makes based on factors such as degree of cholesterol lowering desired, side effects, and cost. "If a patient has only a modest cholesterol elevation, I might prescribe Mevacor," says Johns Hopkins' Miller. "But if a more drastic reduction is needed, especially of LDL, I'll prescribe Lipitor."

The potential for drug interaction is a crucial concern, says FDA's Orloff. "Some statin drugs are known to interact adversely with other drugs, and that information may guide a decision about which statin to use." In June 1998, FDA announced the withdrawal of the drug Posicor (mibefradil), used to treat high blood pressure and stable angina, because it caused adverse reactions in patients taking various other drugs, including Mevacor and Zocor.

Though it is impossible to know yet just how many lives cholesterol-lowering therapies have saved, public health experts say awareness efforts such as the National Cholesterol Education Program are getting the word out to Americans about heart disease, its prevention and management. Reflecting on his own experience with elevated cholesterol, Hoffmann says, "Get informed [about cholesterol]. Read books, search the Internet, look at your risk factors, and, most of all, don't wait to do something about it if you have a [cholesterol] problem."

Food for Thought

One of the main ways blood cholesterol can reach undesirable levels is through a diet high in saturated fat and cholesterol. Fatty cholesterol deposits can collect in blood vessels, raising the risk of heart disease.

Drugs, exercise, and other therapies may be prescribed. But in many cases, cholesterol levels can be lowered by revising dietary habits and limiting the kinds of foods known to boost cholesterol, such as those high in saturated fat. This doesn't mean totally eliminating all your favorite foods, such as desserts, says the National Cholesterol Education Program (NCEP). It means taking a more prudent approach to the kinds and amounts of foods you eat.

When elevated cholesterol is first discovered in a person without heart disease, doctors often start patients on the Step I diet recommended by the American Heart Association and NCEP. On this program, patients should eat: 8 to 10 percent of the day's total calories from saturated fat, 30 percent or less of total calories from fat, less than 300 milligrams of dietary cholesterol a day, and just enough calories to achieve and maintain a healthy weight. A doctor or a registered dietitian can suggest a reasonable calorie level. Food labels also are very helpful in determining how much saturated fat, cholesterol, and calories are in various foods.

If the Step I diet doesn't result in desirable cholesterol levels, doctors may try the Step II diet, which changes the daily saturated fat limits to below 7 percent of daily calories and dietary cholesterol to below 200 milligrams. Step II also is the diet for people with heart disease.

In many patients, blood cholesterol levels should begin to drop a few weeks after starting on a cholesterol-lowering diet. Just how much of a drop depends on factors such as how high the cholesterol level is and how each person's body responds to changes made. With time, cholesterol levels may be reduced 10 to 50 milligrams per deciliter or more, a clinically significant amount.

Tags: Heart Disease

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