Statin Face-Off
	Surprises from the first head-to-head comparison By Sanjay Gupta

Nov. 24, 2003
I have a professional and a personal interest in statins, the cholesterol-lowering drugs that so many people are taking these days. Whereas I don't have a history of heart disease, it runs in my family. Although I exercise regularly and watch what I eat, my LDL (or "bad") cholesterol level has always been a bit elevated (it hovers around 100, which is right at the limit recommended by the U.S. government). So I followed with particular interest the results of the first head-to-head comparison of two of the most popular statins: Lipitor (made by Pfizer) and Pravachol (Bristol-Myers Squibb).

As you may have heard (and if you haven't, Pfizer's marketing department will make sure you soon do), the face-off was a big win for Lipitor. In an 18-month study of 502 patients with average LDLs of 150, Lipitor not only lowered those levels more than Pravachol did (to 79 vs. 110), but it also had a measurable effect on the buildup of plaque in patients' arteries. Pravachol merely slowed the progression of those fatty deposits, whereas Lipitor stopped them cold – and may have even shrunk them a bit.

Dr. Steven Nissen, the cardiologist at the Cleveland Clinic who conducted the research, wasn't prepared to tell me that I should start taking Lipitor. But he thinks this study could change the way doctors look at cholesterol profiles like mine, because the findings suggest that the lower the bad cholesterol level the better. If further studies support this thesis, the government may be under pressure to reduce its recommended LDL level to below 100.

There's still a lot of work to be done. As Nissen points out, it's not yet clear whether Lipitor's protective benefits are due to its power to reduce LDL levels or to its ability to fight inflammation, a major cause of heart disease. And although it seems logical to assume that reducing fatty deposits will translate into fewer heart attacks and deaths, that hasn't been proved. The patients in this study will have to be watched a lot longer than 18 months to find out. Meanwhile, there are more statin studies in the works, including a big one sponsored by Bristol-Myers Squibb (this one was paid for by Pfizer). Those studies could show that there's an even better statin out there. Hmm, maybe I'll wait for that one.

Dr. Gupta is a neurosurgeon and CNN medical correspondent

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