ATLANTA, GA (March 13, 2006) -- A study presented today at the American College of Cardiology's 55th Annual Scientific Session demonstrates, for the first time, that very intensive cholesterol lowering with a statin drug can regress (partially reverse) the buildup of plaque in the coronary arteries. This finding has never before been observed in a study using statin drugs, the most commonly used cholesterol lowering treatment. Previous research had indicated that intensive statin therapy could prevent the progression of coronary atherosclerosis, or arterial plaque build-up, but not actually reduce disease burden. ACC.06 is the premier cardiovascular medical meeting, bringing together more than 30,000 cardiologists to further breakthroughs in cardiovascular medicine.
The intense statin therapy used in this study resulted in significant regression of atherosclerosis as measured by intravascular ultrasound (IVUS), a technique in which a tiny ultrasound probe is inserted into the coronary arteries to measure plaque. The study showed that regression occurred for all three pre-specified IVUS measures of disease burden. The mean baseline LDL cholesterol of 130.4 mg/dL dropped to 60.8 mg/dL in the study patients, an reduction of 53.2 percent. This is the largest reduction in cholesterol ever observed in a major statin outcome trial. Mean HDL cholesterol (43.1 mg/dL at baseline) increased to 49.0 mg/dL, a 14.7 percent increase, which was also unprecedented. The arterial plaque overall was reduced by 6.8 to 9.1% for the various measures of disease burden.
This study was known by the acronym of ASTEROID (A Study To Evaluate the Effect of Rosuvastatin On Intravascular Ultrasound-Derived Coronary Atheroma Burden [ASTEROID] Trial). The trial was conducted at 53 community and tertiary care centers in the United States, Canada, Europe, and Australia. A total of 507 patients had baseline intravascular ultrasound (IVUS) examination and received 40 mg daily of rosuvastatin (brand name CrestorÂ®). IVUS provides a precise and reproducible method for determining the change in plaque, or atheroma, burden during treatment. Atherosclerosis progression was assessed at baseline and after at 24 months of treatment.
"Previous similar studies with statins have shown slowing of coronary disease, but not regression. This regimen significantly lowered bad cholesterol, and surprisingly, markedly increased good cholesterol levels," said Steven Nissen, M.D., F.A.C.C., of the Cleveland Clinic and lead author of the study. Dr. Nissen is also President-Elect of the American college of Cardiology. "We conclude that very low LDL levels (below current guidelines), when accompanied by raised HDL, can regress, or partially reverse, the plaque buildup in the coronary arteries."
I expect a continued drop in death from heart disease relative to the rate of death from cancer. Heart disease is relatively easier to avoid. To tackle cancer we need to get control of all the mechanisms by which cells control their division and spread. That's much harder than avoiding accumulation of junk in arteries. Another very encouraging but more preliminary report on the heart disease front just came out of Johns Hopkins where researchers found they can reverse cardiac hypertrophy in obese mice with hormones.
Working on genetically engineered obese mice with seriously thickened hearts, a condition call cardiac hypertrophy, scientists at Johns Hopkins have used a nerve protection and growth factor on the heart to mimic the activity of the brain hormone leptin, dramatically reducing the size of the heart muscle.
Leptin is a protein hormone made by fat cells that signals the brain to stop eating. Alterations in the leptin-making gene may create leptin deficiency linked to obesity and other defects in weight regulation.
By injecting so-called ciliary neurotrophic factor (CNTF) into mice that were either deficient in or resistant to leptin, the researchers reduced the animals' diseased and thickened heart muscle walls by as much as a third and the overall size of the left ventricle, the main pumping chamber, up to 41 percent, restoring the heart's architecture toward normal.M
Enlarged hearts lead to heart failure and death. Results of the study, supported in part by the National Institutes of Health, are to be published in the March 6 issue of the Proceedings of the National Academy of Sciences.
"These findings suggest there's a novel brain-signaling pathway in obesity-related heart failure and have therapeutic implications for patients with some forms of obesity-related cardiovascular disease," says study senior author Joshua M. Hare, M.D., a professor and medical director of the heart failure and cardiac transplantation programs at The Johns Hopkins University School of Medicine and its Heart Institute.
Ultrasound exams of the hearts after four weeks showed that CNTF decreased the thickness of the wall dividing the heart chambers by as much as 27 percent, decreased the thickness of the wall at the back of the heart by as much as 29 percent and overall volume of the left ventricle by as much as 41 percent.
Note that this study was done with mice. The result still needs confirmation in humans.
Jenkins and his colleagues prescribed a seven-day menu high in viscous fibres, soy protein, almonds and plant sterol margarine to 66 people -- 31 men and 35 women with an average age of 59.3 and within 30 percent of their recommended cholesterol targets. For the first time, 55 participants followed the menu under real-world conditions for a year. They maintained diet records and met every two months with the research team to discuss their progress and have their cholesterol levels measured.
"The participants found it easiest to incorporate single items such as the almonds and margarine into their daily lives," says Jenkins, who is also staff physician of endocrinology at St. Michael's Hospital. "The fibres and vegetable protein were more challenging since they require more planning and preparation, and because these types of niche products are less available. It's just easier, for example, to buy a beef burger instead of one made from soy, although the range of options is improving. We considered it ideal if the participants were able to follow the diet three quarters of the time."
After 12 months, more than 30 per cent of the participants had successfully adhered to the diet and lowered their cholesterol levels by more than 20 per cent. This rate is comparable to the results achieved by 29 of the participants who took a statin for one month under metabolically controlled conditions before following the diet under real-world conditions.
See my previous report on the Jenkins diet: "Ape Man Diet Lowers Cholesterol And Inflammation Marker"
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