Tag Archives: Statin

Statins May Raise Stroke Risk in Some

People who have had a type of stroke caused by bleeding in the brain should avoid taking cholesterol-lowering drugs known as statins, U.S. researchers said
. The drugs increase the risk of a second stroke in these patients.

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It was especially true of people who had strokes in one of their brain’s four lobes, which have a greater chance of recurrence than strokes that occur deep in the brain.

People who have a stroke in one of their lobes have a 22 percent risk of a second stroke when they take statins, compared with a 14 percent risk among those not taking a statin.

According to Reuters:
“The researchers said it is not clear how statins increase the bleeding risk in these patients. It may be having low cholesterol increases the risk of bleeding in the brain, or it may be that statins affect clotting factors in the blood that increase the risk of a brain hemorrhage in these patients.”


Resources:

Reuters January 10, 2011
Archives of Neurology January 10, 2011

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Cholesterol Medication May Decrease the Risk of Cataracts

In addition to taking nutritional supplements such as vitamin E to improve eye health, a new study is suggesting that cholesterol medicine may in fact prevent cataracts, a condition that involves the clouding of the lens and generally affects individuals 55 and older.
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According to research published in the Annals of Epidemiology, men who took medicine to lower their cholesterol had a 40 percent lower risk of developing the eye disease.

After observing 180,000 patients between 1998 and 2007, it was discovered that men who took statins, a common drug found in cholesterol-lowering medication, were less likely to develop the age-related eye disease. Similarly, women were 18 percent less likely to suffer from cataracts as well.

“We believe that the regular use of statins for men and women under the age of 75 can significantly protect them against cataracts,” said study author Dr. Gabriel Chodick.

Cataracts currently affects 60 percent of adults over the age of 60. There are currently 1.5 million surgeries performed each year to fix the vision disease.

Source: Better Health Research .Feb.11 , 2010

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Study Supports Wider Use of Statins

An analysis of studies supports a growing belief that guidelines for prescribing cholesterol-lowering statin drugs should be expanded to include healthy people without established heart disease, cardiologists say.

The meta-analysis of 10 trials involving more than 70,000 participants found that statin therapy reduced overall mortality by 12 percent, major coronary events by 30 percent and strokes by 19 percent.

It supports the findings of the JUPITER trial, reported last year, which noted 54 percent fewer heart attacks and 48 percent fewer strokes among people taking a statin who had normal cholesterol levels but high levels of C-reactive protein, a marker of inflammation, said Dr. Antonio M. Gotto, Jr., dean of Weill Cornell Medical College, a member of the international team reporting on the meta-analysis in the BMJ online.

The analysis shows that “the more risk factors you have, the more aggressive you should be, and the lower the cholesterol level you should consider using statins for,” Gotto said.

Primarily as a result of the JUPITER trial, the U.S. National Institutes of Health has announced that it will review the guidelines for prescribing statins, Gotto said. Those guidelines now focus on reducing elevated levels of LDL cholesterol, the “bad” kind that clogs arteries.

The increased benefit of statins is believed to be due to their anti-inflammatory activity, Gotto said.

The meta-analysis was undertaken before the JUPITER results were reported, Gotto said, because “there was a push against statin use in primary prevention in women and the elderly.” Primary prevention is aimed at people who have cardiovascular risk factors, such as high blood pressure and diabetes, but have not been diagnosed with heart disease.

“We thought it was an important health problem that was not being addressed,” Gotto said.

Previous trials were too small to provide definitive evidence that statin therapy would help women and older people who had risk factors for heart disease, he said. In the studies that were amassed for the meta-analysis, 34 percent of participants were women and 23 percent had diabetes.

Age should be a major consideration when considering statin therapy, but gender should also be taken into account, said Dr. Jacob W. Deckers of the department of cardiology at Erasmus Medical Center in the Netherlands, a member of the international team. The study indicates that statin therapy should be started 10 years earlier in men than in women with the same risk factors, he said.

“Statins should be prescribed in older men with a single risk factor and in older women with several risk factors,” he said.

Only minimal side effects of statin therapy were found in the meta-analysis, Deckers said. No increased risk of cancer was seen, and the incidence of myalgia, the muscle pain that can accompany statin use, was one case in 10,000 persons, he said.

Many people who now take aspirin to reduce cardiovascular risk would be better off with statin therapy, Deckers said. Aspirin’s anti-clotting effects reduce the risk of artery blockage but increase the risk of excess bleeding, he noted.

“It would be better to switch to a statin because of a better benefit-risk ratio,” Deckers added. “With aspirin, the benefit is relatively low and the risk is relatively high.”

More Information you may click on -> U.S. National Library of Medicine.

Source:Health.com. July-1, 2009

 

Statin Cuts Heart Attack Risk in Healthy Too

Should all over-50s take anti-cholesterol drug?

Statins cut the risk of heart attacks by 30 per cent even in healthy people, researchers say.

The cholesterol-busting drugs also reduce the chances of death from all causes by 12 per cent.

The findings, from a review of studies involving people without heart disease, will renew the heated debate over whether everyone over the age of 50 should be prescribed the powerful drugs.

At present they are given only to those at significant risk of a heart attack or stroke.

Many experts say wider access to the cheap drug could save hundreds of thousands of lives while also saving the NHS billions every year.

More than six million adults already take statins, saving around 10,000 lives a year.

The Government’s heart disease czar Roger Boyle says all older people should ideally be taking statins or a polypill, new tablets being developed which contain the drugs.

And last month heart expert Professor Malcolm Law wrote in the British Medical Journal that everyone over 55 should be given statins in the same way that everyone would be offered a vaccine against swine flu if it became serious.

Although low dose statins can be bought over the counter, effective versions of the drugs cannot legally be purchased without a prescription.

The latest review analysed the results of ten large trials involving more than 70,000 patients who did not have established cardiovascular disease.

The trials compared statin therapy with placebo agents or no treatment and tracked patients for an average of four years.

Deaths from all causes were cut by 12 per cent among those taking statins, and the risk of major events such as a heart attack went down by 30 per cent. The risk of a stroke was cut by 19 per cent.

No significant treatment differences were found between men and women, young and old, and those with and without diabetes. There was no raised risk of cancer, feared as a possible side effect.

Dr Jasper Brugts of Erasmus Medical Centre, Rotterdam, which carried out the study, said the findings justify giving statins to those without established cardiovascular disease, but with risk factors such as high blood pressure and diabetes.

Writing on the BMJ website, he aid: ‘People at increased risk for cardiovascular disease should not be denied the relative benefits of long-term statin use.’
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He said men over 65 with risk factors, or older women with diabetes and risk factors, would probably benefit most.

At present, those with established risk factors including diabetes are eligible for statins because they are being prescribed for secondary prevention of heart and circulatory problems.

The big issue is whether taking statins would benefit ‘healthy’ people for primary prevention.

A drive is planned by GPs over the next five years where adults aged 40 to 74 will be invited for a health check to identify heart and stroke risk, as well as kidney disease. Anyone in this age group who is believed to have a 20 per cent risk of suffering a heart attack or stroke over the next ten years will be eligible for the drugs.

It is thought that 15million people will benefit from checks. The move could prevent a further 15,000 heart ‘events’ each year, such as heart attacks and strokes, in addition to the 7,000 heart attacks already being prevented.

But GP Dr Malcolm Kendrick, author of The Great Cholesterol Con, said the jury was still out on whether statins provide any overall health benefit for people without a history of heart disease.

Dr Kendrick, a long-standing sceptic about statins for those at low risk of heart problems, said: ‘The suggestion that people at low risk should be taking drugs for the rest of their lives is not supported by the trials.

In addition to the lack of benefit and expense, statins carry a substantial burden of side effects.’

The Department of Health said it would study the findings.

Source:Mail Online. 1st. July.’09

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Should Statins be Available for Everyone?

They lower cholesterol and heart attack risk and may hold promise against other diseases, including cancer. Doctors consider broadening their use.
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Should statin drugs be put in the water, or what? ¶ More than 13 million Americans are taking these medications to lower their cholesterol and hopefully stave off heart disease — a job the drugs appear to excel at. Statins can lower “bad” LDL cholesterol by 20% to 60%. Over time, this can lower the risk of having a heart attack by about the same amount. ¶ For many years, it was believed that statins worked solely by reducing blood cholesterol, which can build up in sticky plaques in the arteries that supply blood to the heart, potentially blocking blood flow and causing heart attacks. But evidence is mounting that the drugs reduce heart disease risk through more than just their cholesterol-lowering effects. New research suggests they may be beneficial even for people with cholesterol in the normal range. ¶ This has doctors and medical researchers debating whether many more people should be on statins than currently fall under treatment guidelines. Some drug companies and doctors have even argued that low doses of the drugs should be available over the counter, as they are in the United Kingdom.

At the same time, other studies are reporting that statins might help prevent or treat a number of noncardiovascular conditions — including multiple sclerosis, cancer and Alzheimer’s disease. With all this news, many may be wondering, “Should I take a statin, just in case?”

Experts, for the most part, will say only, “Maybe.”

Most of the people at high risk of cardiovascular disease “are going to be safer and live longer if they’re on a statin than if they’re not,” says Nathan Wong, director of the UC Irvine Heart Disease Prevention Program. But that doesn’t hold for people whose risk for heart attacks is very low to begin with, he adds. “I’m not saying that everyone is going to be better on a statin. They need to be used with discretion.”

All six statins available today — atorvastatin (Lipitor), rosuvastatin (Crestor), simvastatin (Zocor), lovastatin (Mevacor), pravastatin (Pravachol) and fluvastatin (Lescol) — work by blocking an enzyme called HMG-CoA reductase.

In the liver, blocking this enzyme shuts down cholesterol production and increases the amount of cholesterol the liver takes out of the bloodstream.

But statins also block HMG-CoA reductase in the cells lining blood vessels, where, among other things, they can reduce inflammation.

Dramatic results
The anti-inflammatory effect of statins has been on many heart experts’ minds since the Nov. 9 announcement of the results of a clinical trial called JUPITER. The trial showed that statin treatment can reduce the risk of heart disease in people with normal cholesterol levels but high levels of inflammation as measured by blood levels of a marker called C-reactive protein (CRP).

A team led by Dr. Paul Ridker of Brigham and Women’s Hospital in Boston and Harvard Medical School found that in 8,901 people with high blood CRP levels, rosuvastatin (Crestor) reduced the risk of a heart attack by 54% and the need for bypass surgery or angioplasty by 46% compared with an equal number of people taking a placebo.

There were 68 heart attacks and 131 bypass surgeries/angioplasties in the placebo group, but only 31 and 71, respectively, in the group taking the statin. There were 48% fewer strokes — 64 versus 33. These effects were so dramatic that regulators stopped the trial, slated to go for four years, after less than two. AstraZeneca, the company that makes Crestor, funded the JUPITER trial.

The results raise an obvious question: Are the cholesterol-lowering effects or the inflammation-reducing effects of statins more important?

Dr. Christopher Cannon, a cardiologist at Brigham and Women’s, says they both play a part: “You have to have some cholesterol get into the arteries [and cause damage]. And if you have inflammation that damages the lining of the arteries, the cholesterol gets in more easily.”

Inflammation can also encourage plaques to rupture, causing clots that block blood flow. “Both [cholesterol buildup and inflammation] are happening simultaneously, and both are inhibited simultaneously with statins,” Cannon says.

Currently, more than 13 million people take statin drugs for elevated LDL cholesterol, and at least 47 million more have cholesterol levels high enough to make them eligible by current National Heart, Lung, and Blood Institute cholesterol guidelines.

Ridker estimates an additional 4 million to 6 million people would be added to the mix if everyone who would have qualified for the JUPITER trial (men over 50, women over 60, LDL cholesterol below 130 mg/dL and CRP above 2 mg/L) started taking a statin.

Anti-inflammatory:

Statins may be good for more than just fighting heart disease.

Very preliminary studies suggest that the anti-inflammatory effects of statins could help treat autoimmune diseases. A small, nine-month study of 36 patients with multiple sclerosis published in April in the journal PLoS One showed that statin treatment, either alone or combined with standard MS treatment, reduced the number of brain lesions characteristic of the disease by 24% and reduced their size by about 12%.

Another pilot study of just seven people, published in September 2007 in the Journal of the American Academy of Dermatology, showed that a statin reduced the severity of the skin disease psoriasis

A combined analysis of 19 studies, published in August in the International Journal of Cancer, found that statin use reduced the risk of advanced prostate cancer by 23%.

And a study published in November in the Journal of the National Cancer Institute showed that men prescribed statins had a 4.1% decline in their blood levels of prostate-specific antigen (PSA), a marker of prostate cancer.

There is some evidence that statins can lower the risk of developing Alzheimer’s disease. An October study of almost 7,000 people in Rotterdam, Netherlands, found that people taking a statin had about a 50% lower risk of Alzheimer’s compared with those who had never used cholesterol-lowering medication. Other studies, however, have failed to find an effect of statins on the risk for dementia or Alzheimer’s disease.

As the benefits of these drugs are experienced by more people, the risks will be too. Though statins are generally considered safe, they do have side effects.

Drugs’ side effects:-
The most commonly reported adverse event associated with statins is muscle pain. A 2006 analysis of seven clinical trials published in Medscape General Medicine found that 2.5% to 6% of patients taking statins reported aches and pains related to their drugs.

Rhabdomyolysis, a breakdown of skeletal muscle that can lead to kidney failure and sometimes death, has also been linked to statins. According to the 2006 Medscape report, less than 0.1% of patients taking statins reported rhabdomyolysis. There was only 0.15 death from rhabdomyolysis per 1 million prescriptions.

Liver effects are also seen in some patients taking statins. In less than 1% of patients taking moderate doses of statins, and in about 2% to 3% of those taking high doses, liver enzyme levels are abnormally high. But the enzyme changes usually subside after discontinuing statin use or switching to a different statin, says Dr. Antonio Gotto, dean of Weill Cornell Medical College in New York.

In 2007, the Food and Drug Administration conducted an investigation into whether statins increase the risk of the fatal neurodegenerative disease amyotrophic lateral sclerosis, also known as Lou Gehrig’s disease, when the agency received a higher than expected number of reports of the disease in people taking statins. Although an analysis of 41 long-term controlled clinical trials reported in September detected no such link, the FDA has said it plans to continue studying the issue.

Dr. Scott Grundy, a professor of internal medicine and director of the Center for Human Nutrition at the University of Texas Southwestern Medical Center at Dallas, says he thinks the drugs, on balance, are safe. But he adds that caution is still warranted, especially when it comes to considering a broad expansion of their use or prescribing them earlier in people’s lives.

Statins have been in use only since the late 1980s, he notes, and so there hasn’t been enough time yet to learn what might happen if someone were to be on the drugs for 30 or 40 years. “It is possible that some of these rare side effects might turn out to be quite important if [statins are] started early in life and continued for years and years,” he says.

Whether statin use is substantially expanded may depend on how the results of the JUPITER trial and other recent research are incorporated into new cholesterol guidelines slated to be released next year by the National Heart, Lung and Blood Institute.

If CRP testing becomes part of the standard battery of tests that guide risk assessment and statin treatment decisions, millions more Americans could find themselves filling a prescription.

Currently, most doctors use CRP testing as a sort of tie-breaker when they are on the fence as to whether a patient is at high enough risk of heart disease to warrant statin therapy. Patients might, for example, have intermediate cholesterol levels but a family history of heart attacks or some other risk factor.

Dr. Mary Malloy, co-director of the adult lipid clinic and director of the pediatric lipid clinic at the UCSF Medical Center, does not think this should change, even though she characterizes the JUPITER results as “very impressive.”

“I am personally not ready to corral everyone over 35 and do CRP testing,” she says.

Wong says it’s important that people take into account a person’s absolute risk when judging whether or not a patient needs a statin.

Of the JUPITER trial, he says, “There was a 44% reduction in cardiovascular events. This sounds very dramatic, and it is.” But the risk of heart attack in those patients was pretty tiny to begin with — 2.8%. The 44% drop took it down to 1.6%.

The bottom line is that monetary cost as well as potential side effects of statins must be weighed against the potential benefits.

Wong’s biggest concern is that people will get the idea that statins are a cure-all — and they’ll stop bothering about habits that could affect their heart health just as much.

“People think statins are magic pills,” he says. “You can’t forget about other risk factors like smoking, diabetes and blood pressure. . . . you have to make sure all these things are adequately controlled.”

Sources: Los Angles Times

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