Long-term Changes of Serum Cholesterol with Cholesterol-altering Drugs in Patients with Coronary Heart Disease

Abstract

In a controlled secondary prevention trial of estrogen and cholesterol-lowering drugs on 570 veterans, all of whom had had one or more episodes of acute myocardial infarction, changes in serum cholesterol were followed for at least five years. The findings included the following: 1) Estrogen, 1.25 mg daily, had no appreciable effect on cholesterol level. 2) Aluminum nicotinate, 4 g/day, resulted in a 20% reduction in cholesterol level for about 2½ years after which levels slowly rose to a level 12% below the baseline level in good adherers; poor adherers had smaller ultimate changes. 3) Dextrothyroxine, 4 mg/day, had a sustained cholesterol-lowering effect of approximately 7% throughout the study. The above values were obtained after adjusting for an underlying upward trend in all cholesterol values during the five-year observation period. 4) Discontinuation of both aluminum nicotinate and dextrothyroxine resulted in a significant rise in cholesterol within three months. 5) The 6% rise in the cholesterol level found in the control group over five years of follow-up could be attributed to aging and laboratory drift. 6) Regression toward the mean rather than pharmacological effect accounted for the greater response to treatment of patients with high initial cholesterol.