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Diet, Exercise Add to Cholesterol Drug Benefits

By Merritt McKinney
Reuters - Health

NEW YORK (Reuters Health) - For reducing the risk of heart attack and other complications of heart disease, cholesterol-lowering drugs are good, but a combination of medications, diet and exercise is better, new research suggests.

In a study of people with heart disease, those who took cholesterol-lowering drugs called statins, stuck to a very-low-fat diet and exercised regularly were 67% less likely to have a heart attack or stroke or to die during the 5-year study than people who only took statins.

"Cholesterol-lowering drugs are only partially effective," study author Dr. K. Lance Gould, told Reuters Health.

The beneficial effects of cholesterol drugs "can be enormously enhanced" by making major lifestyle changes, according to Gould, who is at the University of Texas Medical School at Houston, in Houston, Texas.

"Coronary heart disease can be substantially prevented, stabilized, or in effect reversed by intense lifestyle and drug treatment," Gould said.

Participants in the study were not randomized into separate treatment groups. Instead, the researchers divided the 409 people with coronary artery disease into three groups based on which treatment plan they chose to follow.

Besides taking statins, people in the "maximum" treatment group exercised at least half an hour 4 to 5 days a week and stuck to a diet in which 10% or less of calories came from fat. This diet is more rigorous than what is advocated by the American Heart Association, which recommends that no more than 20% to 30% of calories come from fat.

The "moderate" treatment group included people who followed the AHA diet and took statins or who stuck to a very-low-fat diet without taking cholesterol-lowering drugs. The "poor" treatment group either did not change their diet or take cholesterol drugs or they smoked.

Five years after the study began, about 20% of people on the standard treatment (statins plus the AHA diet) had died, had a heart attack or other cardiac event or needed artery-clearing treatment. In contrast, less than 7% of people who stuck to the most rigorous treatment plan had died or had a cardiac event. Not surprisingly, the rate was highest--more than 30%--in people in the poor treatment group.

Results of the study appear in the January 15th issue of the Journal of the American College of Cardiology.

Although the total fat allowed in the most strenuous diet is low, Gould told Reuters Health that the program is "actually easy and flexible." He noted that it allows for chicken, fish, turkey, Egg Beaters (a yolkless egg product), low-fat dairy products, vegetables, fruit and low-fat starch foods.

Because the researchers did not randomly assign participants into treatment groups, the results must be taken with a grain of salt, according to Dr. William W. Parmley at the University of California at San Francisco. The study cannot prove that lifestyle changes accounted for the improvements, he notes in an editorial that accompanies the study.

Despite these concerns, Parmley said that he agrees with the researchers that using a combination of lifestyle changes and medication rather than relying on "only a pill" is a better approach for treating heart disease.

SOURCE: Journal of the American College of Cardiology.

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