Can cholesterol lowering drugs reverse coronary heart disease?

A pioneering investigation was conducted by B. Greg Brown, M.D., and his colleagues at the University of Washington Medical School in 1990. (Dr. Brown, along with K. Lance Gould, M.D., developed the technique of quantitative coronary angiography, which was the major test used in our research.) In Dr. Brown's important study, men with heart disease and elevated cholesterol levels were divided into three groups. Group A was given high doses of niacin (4 grams per day) plus colestipol (30 grams per day); Group B was given high doses of lovastatin (40 milligrams per day) plus colestipol (30 grams per day); Group C was given a 30 percent fat "low-fat" diet. After two and one-half years, patients in Group A showed a slight amount of overall reversal (0.9 percent) of their coronary blockages and patients in Group B showed even less reversal (0.7 percent). Some reversal of coronary artery blockages occurred in 39 percent of patients in Group A and 32 percent of patients in Group B; 36 percent of Group A and 47 percent of Group B had no change; 25 percent of Group A and 21 percent of Group B had worsening of their coronary artery blockages. Group C patients also became worse, showing a 2.1 percent worsening of their coronary artery blockages.

If lowering cholesterol were the primary factor in causing reversal of heart disease, then the blockages of most of the patients in the studies by Dr. Brown who were taking cholesterol-lowering drugs should have shown reversal, since almost all of these patients had substantial decreases in blood cholesterol levels due to these drugs. Yet only the minority showed reversal.