Should cholesterol levels be reduced rapidly?

This paper examined the effect of rapidly reducing cholesterol levels.  

High levels of fat in the body increases the risk of heart disease. Studies have shown that intensively reducing levels of cholesterol, with treatments such as statins (type of drug that reduces levels of cholesterol), can help patients with heart disease and prevent heart attacks. One study recommended that low-density lipoprotein cholesterol (LDL, bad type of cholesterol) should be less than 100 mg/dL and be reduced by 20 to 30%.

This study examined the long-term effects of rapid LDL cholesterol reduction. This study included 427 patients who were treated with percutaneous coronary intervention (a non­surgical procedure used to treat the narrowed coronary arteries of the heart) following a heart attack. Patients were randomly allocated to receive one of two statins: atorvastatin (Lipitor) or pravastatin (Pravachol) daily. Following 4 weeks of treatment, patients were divided into two groups. The early reduction group (204 patients) achieved a 30% or more reduction of LDL cholesterol levels. The late reduction group (223 patients) did not achieve a low-density lipoprotein cholesterol reduction of 30% or more.

At the start of the study, LDL cholesterol levels were higher in the early reduction than late reduction group. However 4 weeks later, LDL cholesterol levels were significantly lower in the early reduction group than late reduction group.

A major adverse event (undesired effect of treatment) related to the heart occurred in 3.4% of patients in the early reduction group and 9.4% of patients in the late reduction group. The rate of a major adverse event related to the heart was similar between patients treated with atorvastatin and those treated with pravastatin. 2.9% of patients in the early reduction group and 7.2% of patients in the late reduction group died. Heart attack occurred in no patients in the early reduction group and in 0.9% of patients in the late reduction group. Stroke occurred in 0.5% of patients in the early reduction group and in 2.2% of patients in the late reduction group. Heart failure occurred in 2.5% of patients in the early reduction group and 2.2% of patients in the late reduction group.

The authors concluded that a rapid reduction of low-density lipoprotein cholesterol levels benefits patients.