Women and kids join the cholesterol fray.

Women and kids join the cholesterol fray

A regimen of cholesterol-lowering drugs shinks fatty plaques narrowing the coronary arteries in women -- as well as men -- who suffer from a genetic defect that puts them at high risk of heart attacks, a new study shows. In a field clogged with studies involving men, this report also gives the first close look at how women respond to such drugs, says Basil Rifkind of the National Heart, Lung, and Blood Institute in Bethesda, Md.

Not all children with high blood cholesterol will grow up to have dangerous levels of cholesterol as adults, a second study finds. Both studies appear in the Dec. 19 JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.

In the first trial, lasting 26 months, endocrinologist John P. Kane and his colleagues at the University of California, San Francisco, studied 41 women and 31 men with familial hypercholesterolemia, an inherited disorder that leads to dangerously high levels of low-density lipoproteins (LDL), cholesterol-carrying molecules that deposit fatty debris on artery walls. At the study's start, all volunteers exhibited a narrowing from plaque in their coronary arteries, the vessels supplying heart muscle with blood.

The California team advised the entire group to eat a diet low in cholesterol and saturated fats. Roughly hlf the men and women received aggressive drug therapy to lower their blood cholesterol, the rest mild or no treatment with cholesterol-lowering drugs. The researchers compared before and after X-rays of the volunteers' coronary arteries, obtained by angiography. Their computer analysis showed an average 1.53 percent decrease in vessel obstruction among individuals receiving aggressive drug therapy, compared to an average 0.8 percent rise in the amount of plaque choking coronary arteries in the largely untreated group.

When the California team specifically analyzed data on the women, it confirmed that artery obstruction progressed in women receiving largely dietary guidance, and diminished in women receiving aggressive drug treatment.

Such results may blunt recent criticism regarding the male bias in cardiovascular research. However, a second report by Ronald M. Lauer and William R. Clarke of the University of Iowa in Iowa City suggests the fray over childhood blood cholesterol level will continue.

The pair analyzed blood cholesterol data collected in the 1970s from 2,367 children and teenagers attending school in Muscatine, Iowa. More than a decade later, the researchers administered follow-up cholesterol tests to 1,461 study participants, then aged 20 to 30. The Iowa team discovered that 75 percent of girls and 56 percent of boys who had high blood cholesterol levels -- exceeding the 75th percentile -- no longer had high values when tested as young adults.

Because cholesterol screens do not reliably identify future at-risk individuals -- and hence may unduly frighten some parents -- Thomas B. Newman of the University of California, San Francisco, questions the value of subjecting all children to them. But Gerald S. Berenson of the Louisiana State University Medical Center in New Orleans counters that routine cholesterol tests correctly identify enough children at risk of future heart disease to justify their being part of any public health campaign against heart disease.