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    Most people with high cholesterol do not successfully lower levels of LDL

    Even when patients are prescribed cholesterol-lowering drugs, often their cholesterol fails to decrease significantly, a new study shows.

    In the study, researchers assessed the percentage of participants in the national Lipid Treatment Assessment Project (L-TAP) whose LDL levels met federal 1997 National Cholesterol Education Program (NCEP) guidelines. Almost 85 percent had been prescribed lipid-lowering medications.

    Among the 4,888 study participants, most of whom were white and middle aged, only 38 percent of patients achieved NCEP levels. Of these, 23 percent had fewer than two risk factors for coronary heart disease (CHD) and no evidence of CHD, 47 percent had two or more risk factors and no evidence of CHD, and 30 percent had established CHD. Dr. Thomas A. Pearson of the University of Rochester School of Medicine in New York and colleagues report the findings in the February 28, 2000, Archives of Internal Medicine.

    Those failing to meet their goal included 68 percent of the participants who were at low risk of developing heart disease, 37 percent of high-risk participants, and 18 percent of those who already had heart disease. These differences were probably because of the groups' different LDL goals, the authors believe.

    Other studies have also shown that cholesterol-lowering drugs may produce disappointing results, but those studies had been on small groups of patients, the researchers note.

    Among patients receiving lipid-lowering therapy from one type of medication, patients were more likely to lower their cholesterol when taking statins, compared to other types of drug therapy.

    People with more education about their health and their medications were more likely to meet the guidelines than those with less education. Success rate "was independent of the patient's height, weight, place of residence, and whether the patient had medical insurance," the team notes. Male and female patients had similar success rates.

    The study also assessed the effect of physician advice to lower cholesterol with diet and exercise. Both factors were independent predictors of success in reaching LDL-C goals. "Nonetheless, a cholesterol-lowering diet remains a cornerstone of lipid-lowering therapy (in conjunction with drug therapy)," the authors write.

    Of the group, 15 percent received dietary advice only. Of these, 34 percent successfully lowered their LDL levels.

    The latest NCEP guidelines from the National Heart, Lung, and Blood Institute (1997) suggest that:

    For patients without CHD, LDL-C levels to initiate dietary therapy are 160 mg/dL or more in low-risk patients, and 130 mg/dL or more in high-risk patients.

    Target goals of therapy including lowering LDL cholesterol levels to the following levels before initiating therapy: to below 160 mg/dL for low-risk patients, and below 130 mg/dL in high-risk patients.

    Why aren't the prescriptions working better? The researchers blame "low dosages of drugs, limited drug effectiveness, inappropriate choice of drug, other drug limitations (e.g., tolerability), and noncompliance of patients with recommended treatment." Non-compliance, however, was not a major factor, they add.

    "These findings indicate that a more aggressive treatment of dyslipidemia is needed to attain goals established by NCEP guidelines," the authors write.

    Parke-Davis Co, which makes cholesterol-lowering drugs, funded the study.



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