Cholesterol Management Community

"But there is no proof that if it lowers heart attacks."


That is the ultimate outcome. Does something prevent heart attacks and save lives?


Its a tough question because its so difficult to measure. When comparing two groups, we can compare the number of heart attacks in each group, but we really don't know who was destined to have a heart attack and who wasn't. Its difficult to measure how any treatment may have avoided an event in any individual.


Bill, they say statins stabilize plaque. Where does that data come from? What do they mean by stabilize?


Bobby

http://www.medscape.com/viewarticle/504394_4

"
Plaque Stabilization and Decreased Plaque ThrombogenicityExperiments have demonstrated that cholesterol reduction is accompanied by favorable alterations in a number of mediators of plaque stability.[a title="Link: undefined">[39,40> Studies have shown that statins decrease macrophage number, reduce expression of tissue factor, adhesion molecules, and matrix metalloproteinases within plaque.[a title="Link: undefined">[39> The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors also reduce the oxidation of LDL, macrophage uptake of LDL,[a title="Link: undefined">[24,25> and reduce monocyte adhesion to endothelium.[a title="Link: undefined">[25> Lipid lowering with statins results in increased smooth-muscle cell content (a surrogate of plaque stability) and decreased collagen degradation (which may further enhance plaque stability).[a title="Link: undefined">[39> Clinical studies support these experimental observations and provide further evidence that statin therapy may be associated with plaque stabilization. Statins may also inhibit atherogenesis through the inhibition of vascular smooth-muscle cell proliferation and migration, and thus attenuate plaque growth and new lesion formation.[a title="Link: undefined">[41>
Another factor which may contribute toward decreased risk for stroke with statin therapy is the effect of statins on platelets and the endogenous balance of thrombosis/thrombolysis.[a title="Link: undefined">[40> Statin therapy decreases platelet activation and aggregation, and thereby may decrease the propensity toward thrombosis.[a title="Link: undefined">[10,23,42,43> Statin therapy inhibits tissue factor expression by macrophages, which plays an integral role in blood coagulation and is an important determinant of plaque thrombogenicity.[a title="Link: undefined">[23,25> There also may be a reduction in plasminogen activator inhibitor activity, which would facilitate fibrinolysis.[a title="Link: undefined">[23> All of these factors may contribute toward decreased risk for stroke seen in the statin studies. These statin effects may lead to decreased thrombus formation and thereby influence the development of clinical activity related to atherosclerotic plaque."


I think that the basic information comes from lab studies (animals?) Then in limited clinical studies they look for some of the same biological markers that they saw in the animals.


I am mostly speculating on this, because I don't want to have to run down all of the references.


http://content.onlinejacc.org/cgi/content/full/49/2/271


Atherosclerosis Regression, Vascular Remodeling, and Plaque Stabilization[a title="Link: undefined" name="RFN1"> *
http://health.usnews.com/usnews/health/articles/040322/22healy.htm

Meet the cholesterol busters

Thank you Bill. I now have clearer picture of what thy mean by the word stabilize.

I did read the Medscape article and noticed the conclusions were all "may" do this and "may" do that.

The more i think about it, I guess what I am looking for is conclusive evidence statins stop the growth or prevent rupturing of artery plaque, from an independent unbiased study.

Does such a thing exists?

The more i think about it, I guess what I am looking for is conclusive evidence statins stop the growth or prevent rupturing of artery plaque, from an independent unbiased study.

Not that I know of.

And I can almost guarantee that there won't be any such thing.

Other than a few basic things, such as you need to stop bleeding, you will never find it in medicine.

There is just too wide a variation of people.

And much of this comes from experiements that could not be done on humans.