Tag: statins

Categories : Metabolic DisordersTags :

Researchers Uncover Possible Cause of Muscle Pain from Statins

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The discovery may explain side effects from taking statins, opening the door to future therapies that could make statins easier to tolerate.

Photo by Towfiqu Barbhuiya on Unsplash

Millions of people rely on statins to lower cholesterol and reduce the risk of heart attack and stroke. But for some, the drugs come with an unwelcome trade-off: muscle pain, weakness and exercise intolerance that can make it difficult to continue treatment.

Now, researchers at McMaster University have uncovered a biological pathway that may explain why those side-effects occur, opening the door to future therapies that could make statins easier to tolerate while maintaining their life-saving cardiovascular benefits.

Published in Science Advances, the study identifies an immune and metabolic mechanism that drives statin-induced muscle damage, challenging longstanding assumptions about how these side-effects develop.

“Statins are among the most effective medications we have for reducing cardiovascular disease risk and preventing early death,” said senior author Jonathan Schertzer, a professor in McMaster’s Department of Biochemistry and Biomedical Sciences.

“Unfortunately, muscle side-effects lead some people to reduce their dose or stop taking the medication altogether. We wanted to understand why this happens and whether it might be possible to separate the side effects from the benefits.”

Statin-associated muscle symptoms affect an estimated seven to 29 per cent of people who take the drugs. While researchers have long known that statins can sometimes cause muscle problems, the biological mechanisms behind those effects have remained unclear.

Led by first authors Nazli Robin and Nicole Barra of the Schertzer Lab at McMaster, the team found statins can disrupt how muscle cells produce energy, triggering an immune response that damages muscle tissue. In experiments using muscle cells and mouse models, researchers were able to prevent much of that damage by blocking the immune response.

“One of the most exciting findings of the research is that the mechanism causing muscle side-effects appears to be separate from the mechanism that lowers cholesterol,” said Schertzer. “That suggests it may one day be possible to target the side-effects without interfering with the cardiovascular benefits that make statins so valuable.”

The study also revealed an unexpected link between metabolism and immunity. Researchers found that changes in muscle-cell metabolism triggered an immune response within the cells themselves, providing new insight into how inflammation can contribute to drug side-effects.

Although additional research will be needed before the findings can be translated into therapies for patients, the discovery identifies several potential targets for future drug development aimed at preventing statin intolerance.

“These findings give us a clearer understanding of why some patients experience muscle symptoms and provide promising directions for making these important medications safer and more effective in the future,” added Schertzer.

Source: McMaster University

Categories : Cardiovascular DiseaseTags :

Lipid Lowering: Why 70mg/dL May Not Be Low Enough

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Current clinical guidelines stress that lower LDL cholesterol levels significantly reduce the risk of major cardiac events. Essential strategies for treatment include heart-healthy lifestyle changes and pharmacological interventions using statins, ezetimibe, and PCSK9 inhibitors. Early intervention is vital, as the cumulative exposure to high cholesterol over time – often termed “LDL years” – determines the onset of vascular disease. But a major question has remained as to whether more aggressive lip-lowering targets is worth the potential side effects such as kidney damage.

Now, a new clinical trial published in NEJM provides evidence that an intensive target of less than 55mg/dL is superior for preventing secondary complications. In the Ez-PAVE trial, researchers in South Korea investigated whether this more intensive provided better protection than the conventional goal of less than 70mg/dL. The study found that patients in the intensive group experienced a significant reduction in cardiovascular events over a three-year period. The researchers conclude that their findings support stricter lipid-lowering guidelines, which can safely and effectively improve long-term patient outcomes.

Categories : Cardiovascular DiseaseTags :

Statins do not Cause the Majority of Their Listed Side Effects

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Statins do not cause the majority of the conditions that have been listed in their package leaflets, including memory loss, depression, sleep disturbance, and erectile and sexual dysfunction, according to the most comprehensive review of possible side effects. The study was led by researchers at Oxford Population Health and published in The Lancet.

Cardiovascular disease results in around 20 million deaths worldwide and causes around a quarter of all deaths in the UK. Statins are highly effective drugs that lower LDL (‘bad’) cholesterol levels and have been repeatedly proven to reduce the risk of cardiovascular disease. However, there have been concerns about possible side effects.

The researchers gathered data from 23 large-scale randomised studies from the Cholesterol Treatment Trialists’ Collaboration: 123 940 participants in 19 large-scale clinical trials comparing the effects of statin therapies against a placebo, and 30 724 participants in four trials comparing more intensive versus less intensive statin therapy.

They found similar numbers of reports for those taking the statins and those taking the placebo for almost all the conditions listed in package leaflets as possible side effects. For example, each year, the number of reports of cognitive or memory impairment was 0.2% in those taking the statins, but also 0.2% in those taking the placebo. This means that while people may notice these problems whilst taking statins, there is no good evidence that they are caused by the statin.

Key findings:

  • There was no statistically significant excess risk from statin therapy for almost all the conditions listed in package leaflets as potential side effects.
  • Taking a statin did not cause any meaningful excess of memory loss or dementia, depression, sleep disturbance, erectile dysfunction, weight gain, nausea, fatigue or headache, and many other conditions.
  • There was a small increase in risk (about 0.1%) for liver blood test abnormalities. However, there was no increase in liver disease such as hepatitis or liver failure, indicating that the liver blood test changes do not typically lead to more serious liver problems.

Christina Reith, Associate Professor at Oxford Population Health and lead author of the study, said: ‘Statins are life-saving drugs used by hundreds of millions of people over the past 30 years. However, concerns about the safety of statins have deterred many people who are at risk of severe disability or death from a heart attack or stroke. Our study provides reassurance that, for most people, the risk of side effects is greatly outweighed by the benefits of statins.’

Previous work by the same researchers established that most muscle symptoms are not caused by statins; statin therapy caused muscle symptoms in only 1% of people during the first year of treatment with no excess thereafter. It has also shown that statins can cause a small increase in blood sugar levels, so people already at high risk may develop diabetes sooner.

Professor Bryan Williams, Chief Scientific and Medical Officer at the British Heart Foundation, said: ‘These findings are hugely important and provide authoritative, evidence-based reassurance for patients. Statins are lifesaving drugs, which have been proven to protect against heart attacks and strokes. Among the large number of patients assessed in this well-conducted analysis, only four side effects out of 66 were found to have any association with taking statins, and only in a very small proportion of patients.

‘This evidence is a much-needed counter to the misinformation around statins and should help prevent unnecessary deaths from cardiovascular disease. Recognising which side effects might genuinely be associated with statins is also important as it will help doctors make decisions about when to use alternative treatments.’

Professor Sir Rory Collins, Emeritus Professor of Medicine and Epidemiology at Oxford Population Health and senior author of the paper said: ‘Statin product labels list certain adverse health outcomes as potential treatment-related effects based mainly on information from non-randomised studies which may be subject to bias. We brought together all of the information from large randomised trials to assess the evidence reliably. Now that we know that statins do not cause the majority of side effects listed in package leaflets, statin information requires rapid revision to help patients and doctors make better-informed health decisions.’

All of the trials included in the analyses were large-scale (involving at least 1000 participants) and tracked patient outcomes for a median of nearly five years. The trials were double-blind, meaning that neither the trial participants nor those managing the participants or leading the study knew who was receiving which treatment, to avoid potential biases due to knowledge of treatment allocation. The list of possible side effects was compiled from those listed for the five most commonly prescribed statins.

The paper, ‘Assessment of adverse effects attributed to statin therapy in product labels: a meta-analysis of double-blind randomised controlled trials,’ is published in The Lancet.

Source: Oxford University

Categories : Cardiovascular DiseaseTags :

Calcium Leak is the Culprit Behind Statin Muscle Pains

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Many people stop taking cholesterol-lowering statins because they experience muscle aches, weakness, and fatigue. A new study by Columbia researchers now suggests that at least for some people, the side effects arise when statins bind to a protein in muscle cells and cause a leak of calcium ions inside the cells.

“It is unlikely that this explanation applies to everyone who experiences muscular side effects with statins, but even if it explains a small subset, that’s a lot of people we could help if we can resolve the issue,” says Andrew Marks, chair of the Department of Physiology and Cellular Biophysics at the Vagelos College of Physicians and Surgeons.

About 10% of adults taking statins experience these muscular side effects.

“I’ve had patients who’ve been prescribed statins, and they refused to take them because of the side effects. It’s the most common reason patients quit statins, and it’s a very real problem that needs a solution,” says Marks.

Electron microscopy pinpoints statin-muscle interaction

Statins’ muscular side effects have puzzled researchers since the drugs hit the market in the late 80s. Statins are designed to lower cholesterol by binding to an enzyme involved in cholesterol synthesis. But statins also bind to other “off-target” molecules, and some previous studies have suggested that muscular side effects occur when statins bind to a specific protein in muscle.

With cryo-electron microscopy, a technique that can image molecules down to individual atoms, the researchers of the new study documented this binding and uncovered the precise details of the interaction.

Simvastatin molecules bind to two locations on a muscle protein, called the ryanodine receptor, which opens a channel in the receptor. The flow of calcium through the open channel could explain the muscular side effects of statins.

The images revealed two locations on the muscle protein, called the ryanodine receptor, where a statin called simvastatin binds, opening a channel in the receptor and allowing calcium to flow through.

The calcium leak could explain the muscular side effects of statins, Marks says, by weakening the muscle directly or by activating enzymes that degrade muscle tissue.

Building a better statin

The new images also suggest that statins could be redesigned so they do not bind the ryanodine receptor but retain their cholesterol-lowering ability.

Marks is now collaborating with chemists to create such a statin.

Plugging the calcium leak could be another option: Statin-induced calcium leaks in mice can be closed, the researchers showed, with an experimental drug developed in the Marks lab for other conditions involving calcium leaks.

These drugs are currently being tested in people with rare muscle diseases. If it shows efficacy in those patients, we can test it in statin-induced myopathies,” Marks says

Source: Columbia University Irving Medical Center

Categories : Cardiovascular Disease Mental HealthTags :

Extensive Study Refutes the Notion that Statins Have Antidepressant Effect

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Lipid-lowering medicines, known as statins, are prescribed in cases of high cholesterol levels, to reduce the risk of atherosclerosis, heart attack and stroke. The results of some small studies suggest that statins could also have an antidepressive effect. Researchers from Charité – Universitätsmedizin Berlin have now conducted an extensive study to investigate this claim. However, they could not verify that statins cause any additional antidepressive effects. As a result, the researchers suggest following the general guidelines and prescribing statins to help lower cholesterol, but not to manage depression. The study has now been published in JAMA Psychiatry.

Cholesterol-lowering drugs are the most commonly prescribed medicines globally. They have anti-inflammatory effects and lower the production of cholesterol in the liver, which in turn reduces the risk of developing cardiovascular diseases. In the past, numerous small studies have suggested that statins may also have antidepressive effects, alongside these more common properties. “If statins really did have this antidepressive effect, we could kill two birds with one stone,” says study leader Prof Christian Otte, Director of the Department of Psychiatry and Neurosciences on the Charité Campus Benjamin Franklin. “Depression and adiposity, or obesity, are among the most common medical conditions globally. And they actually often appear together: Those who are obese are at a higher risk of depression. In turn, those with depression are at a higher risk of obesity.” Obese patients often have higher cholesterol levels, so statins are administered to reduce the risk of cardiovascular diseases. But could they also alleviate depression?

An extensive, controlled study

Led by Christian Otte, the research team conducted a comprehensive study to investigate the potential antidepressive effects of statins that have been suggested. A total of 161 patients took part in the study, all of whom suffered from both depression and obesity. During the 12-week study, all participants were treated with a standard antidepressant (Escitalopram). Half of the participants also received a cholesterol-lowering drug (Simvastatin), while the other half were given a placebo. It was decided at random who would receive statins and who would be given the placebo – the recipients of each were unknown to both the medical team and the participants. This ensured a randomized and double-blind study that would produce reliable results. “This method should show us whether we can observe a stronger antidepressive effect among participants treated with statins, compared to those in the placebo group,” explains co-lead author Dr. Woo Ri Chae, Charité BIH Clinician Scientist at the Department of Psychiatry and Neurosciences.

The researchers used established clinical interviews and self-completed questionnaires to record the severity of depression in the patients at the beginning and end of the study. Blood samples were taken from the participants to determine their blood lipid levels and level of the C-reactive protein (CRP), which are known indicators of inflammatory processes in the body. “People with obesity and/or depression commonly exhibit slightly raised inflammatory markers in the blood. For some of those affected, this can actually be the cause of depression,” explains Christian Otte. “And this is precisely where we began with our hypothesis on the potential antidepressive effect of statins: If administering statins leads to an improvement in inflammatory markers, could this also possibly be accompanied by an antidepressive effect for some of the study participants?”

Traditional antidepressants remain the gold standard

At the beginning of the study, the participants ranged from moderately to severely depressed. Over the course of the 12-week study, the depression symptoms in all patients showed clear improvement – there was, however, no difference between those who received statins and those in the placebo group. “Administering the cholesterol-lowering drug improved blood lipid levels, as expected, and the inflammatory marker CRP also displayed a marked reduction,” says Woo Ri Chae. “So, unfortunately, this does not point to an additional antidepressive effect.” Christian Otte adds: “When it comes to treating depression, statins therefore have no additional benefit. To our present knowledge, traditional antidepressants remain the gold standard.” According to current guidelines, statins should be prescribed to reduce the risk of atherosclerosis and cardiovascular diseases. The researchers recommend that the same should naturally also apply for patients suffering from depression.

In further studies, Christian Otte’s team will conduct a more thorough analysis of the blood samples taken as part of this research on a cellular and molecular level, to reveal potential differences and correlations. The researchers are also continuing to work at full speed on improved strategies for treating patients with depression who also suffer from other conditions.

Categories : Emergency MedicineTags :

Statins May Reduce Mortality Risk by 39% for Patients with Septic Shock

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Each year in the US alone, approximately 750 000 patients are hospitalised for sepsis, of which approximately 27% die. In about 15% of cases, sepsis worsens into septic shock, characterised by dangerously low blood pressure and reduced blood flow to tissues. The risk of death from septic shock is even higher, between 30% and 40%.

The earlier patients with sepsis are treated, the better their prospects. Typically, they receive antibiotics, intravenous fluids, and vasopressors to raise blood pressure. But now, a large cohort study in Frontiers in Immunology has shown for the first time that supplementary treatment with statins could boost their chances of survival.

“Our large, matched cohort study found that treatment with statins was associated with a 39% lower death rate for critically ill patients with sepsis, when measured over 28 days after hospital admission,” said Dr Caifeng Li, the study’s corresponding author and an associate professor at Tianjin Medical University General Hospital in China.

Statins are best known as a protective treatment against cardiovascular disease, which function by lowering ‘bad’ LDL cholesterol and triglycerides, and raising ‘good’ HDL cholesterol. But they have been shown to bring a plethora of further benefits, which explains the burgeoning interest in their use as a supplementary therapy for inflammatory disorders, including sepsis.

Not just lowering cholesterol

“Statins have anti-inflammatory, immunomodulatory, antioxidative, and antithrombotic properties. They may help mitigate excessive inflammatory response, restore endothelial function, and show potential antimicrobial activities,” said Li.

The authors sourced their data from the public Medical Information Mart for Intensive Care-IV (MIMIC-IV) database, which holds the anonymised e-health records of 265 000 patients admitted to the emergency department and the intensive care unit of the Beth Israel Deaconess Medical Center of Boston between 2008 and 2019. Only adults with a diagnosis of sepsis hospitalised for longer than 24 hours were included here.

The authors compared outcomes between patients who received or didn’t receive any statins during their stay besides standard of care, regardless of the type of statin. Unlike in randomised clinical trials, the allocation of treatments is not determined by random in observational studies like the present cohort study. This means that it is in principle hard to rule out that an unknown underlying variable affected allocation, for example if physicians unconsciously or on purpose were prone to give statins to those patients most likely to benefit from them.

However, Li and colleagues used a technique called ‘propensity score matching’ to minimize the risk of such bias: they built a statistical model to determine a likelihood score that a given patient would receive statins, based on their medical records, and then found a matching patient with a similar score, but who didn’t receive statins. In the final sample, 6070 critical patients received statins while another 6070 did not.

Source: Frontiers

Categories : Cardiovascular Disease Metabolic DisordersTags :

Timely Initiation of Statins in Diabetes Shown to Dramatically Reduce Cardiovascular Risk

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Despite clinicians recommending that many patients with diabetes take statins, nearly one in five opt to delay treatment. In a new study, researchers from Mass General Brigham found that patients who started statin therapy right away reduced the rate of heart attack and stroke by one third compared to those who chose to delay taking the medication. The results, which can help guide decision-making conversations between clinicians and their patients, are published in the Journal of the American Heart Association.

“I see patients with diabetes on a regular basis, and I recommend statin therapy to everyone who is eligible,” said senior author Alexander Turchin, MD, MS, of the Division of Endocrinology at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system. “Some people refuse because they want to first try lifestyle interventions or other drugs. But other interventions are not as effective at lowering cholesterol as starting statin therapy as soon as possible. Time is of the essence for your heart and brain health.”

Heart attacks and strokes remain the leading cause of complications and mortality for patients with diabetes. Statin therapy reduces risk of these cardiovascular events by preventing plaque buildup in the blood vessels.

The researchers used an artificial intelligence method called Natural Language Processing to gather data from the electronic health records of 7239 patients at Mass General Brigham who ultimately started statin therapy during the nearly 20-year study period. The median patient age was 55, with 51% being women, 57% white, and a median HbA1c of 6.9.

Nearly one-fifth (17.7%) of the patients in the study declined statin therapy when it was first recommended by their clinicians, then later accepted the therapy (after a median of 1.5 years) upon repeated recommendation by their clinician. Of those who delayed, 8.5% had a heart attack or stroke. But for patients who started statins immediately, the rate of those cardiovascular events was just 6.4%.

“Clinicians should recognize the increased cardiovascular risk associated with delaying statin therapy for patients with diabetes and use this information to guide shared decision-making conversations with their patients,” said Turchin.

Source: Mass General Brigham

Categories : Cancer Cardiovascular DiseaseTags :

Statin Use May Improve Survival in Patients for Some Blood Cancers

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Patients with chronic lymphocytic leukaemia (CLL) or small lymphocytic lymphoma (SLL) who were taking cholesterol-lowering statin medications at the start of their cancer treatment had a 61% lower risk of dying from their cancer compared to similar patients who were not taking statins, according to a study published today in the journal Blood Advances.

“This is the first systematic evaluation of the association of statin use with survival outcomes in patients with CLL or SLL who have been treated with contemporary targeted agents such as ibrutinib,” said the study’s principal investigator, Ahmad Abuhelwa, PhD, an assistant professor of pharmacy practice and pharmacotherapeutics at the University of Sharjah in the United Arab Emirates. “Our results highlight a strong link between statin use and improved survival in this patient population.”

CLL is a slow-growing cancer that starts in the blood-forming cells of the bone marrow and is the most common form of leukaemia in adults in the United States. SLL, also a slow-growing cancer, affects the same type of cells as CLL but starts in lymphoid tissues such as the spleen instead of in the blood-forming cells.

Statins are among the most widely prescribed medications. It’s estimated that over 90 million adults in the United States take a statin drug to reduce their cholesterol levels and lower their risk for heart disease, which can lead to heart attacks or strokes. Previous studies have linked statin use to reduced death rates from several cancers, including CLL, said Dr Abuhelwa. However, those studies did not evaluate the effects of statin use in patients who were treated with newer cancer therapies such as the targeted drug ibrutinib, he said.

In the current study, Dr Abuhelwa and his colleagues analysed data from 1467 patients with CLL or SLL who participated in four international clinical trials conducted between 2012 and 2019. In these trials, patients were randomly assigned to treatment with ibrutinib either alone or in combination with other anti-cancer drugs, or to a drug regimen that did not include ibrutinib. A total of 424 patients (29%) were taking a statin at the time they started treatment across the four clinical trials. The median patient age was 65, and 66% were men; 92% had CLL, which was either newly diagnosed, had come back, or had not responded to prior treatment.

The study’s primary endpoints were cancer-specific survival (how long patients lived after starting treatment before dying specifically from their cancer), overall survival (how long patients lived after starting treatment, regardless of the cause of death), and progression-free survival (how long patients lived after starting treatment before their cancer worsened or they died from any cause). The secondary endpoint was the proportion of patients who experienced severe or life-threatening adverse events. The median follow-up time for all patients enrolled in the four trials was five years for overall survival and 22 months for progression-free survival.

To account for potential confounding factors, the investigators adjusted their analysis for variables including each patient’s diagnosis, age, sex, weight, physical functioning (as assessed by doctors), disease severity, length of time since their diagnosis, number of co-existing illnesses, use of other medications for heart conditions or high blood pressure, and the specific anti-cancer treatment regimen received.

Results showed that, regardless of any of these factors, patients who took a statin had, on average, a 61% reduced risk of dying from their cancer, a 38% reduced risk of death from any cause, and a 26% reduced risk of disease progression. Importantly, statin use did not increase the likelihood of severe or life-threatening adverse events.

“These findings don’t allow us to say for certain that statins directly improve cancer outcomes,” said Dr. Abuhelwa. “However, the fact that this association remained strong even after accounting for multiple factors makes it an important area for future research.” As next steps, he recommended conducting laboratory studies to better understand how statins may influence cancer biology, as well as prospective clinical trials in which patients with CLL or SLL are randomly assigned to take a statin or not.

The study has several limitations given its observational nature. For example, patients enrolled in clinical trials tend to be monitored more closely than those who receive treatment outside of a clinical trial, so the study findings may not be generalizable to patients treated in non-clinical trial settings. Additionally, because patients used various statins at different doses, the study could not determine the effects of specific statin types, doses, or duration of use on patients’ survival.

“While our results are very promising, we can’t recommend starting statins for CLL/SLL treatment based on this study alone,” Dr Abuhelwa said. “Future clinical trials are needed to determine definitively whether statins have a direct benefit on cancer survival.”

Source: American Society of Hematology

Categories : Cardiovascular Disease New Compounds and TreatmentsTags :

Add-on for Statins Greatly Reduces Recurrence of Heart Attacks

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Photo by Mikhail Nilov: https://www.pexels.com/photo/paramedics-using-a-defibrillator-on-a-patient-8942635/

Patients who receive an add-on medication soon after a heart attack have a significantly better prognosis than those who receive it later, or not at all. These are the findings of a new study from researchers at Lund University in Sweden and Imperial College London.

Their analysis suggests that treating patients earlier with a combination of statins and the cholesterol-lowering drug ezetimibe could prevent thousands of new heart attacks in the UK over a decade.

Cardiovascular disease is by far the most common cause of death worldwide, with heart attack (‘myocardial infarction’) being the most common acute event.

For those who survive a heart attack, the risk of a new heart attack is greatest in the first year after the initial event because the blood vessels are more sensitive, making it easier for blood clots to develop.

Our findings suggest that a simple change in treatment guidelines could have a huge impact on patients and reduce the demand on the NHS.

Professor Kausik Ray, School of Public Health

Reducing LDL or “bad” cholesterol in the blood can stabilise changes in the vessels, decreasing the risk for new events.

The current treatment guidelines for patients are high-potency statins immediately after a heart attack, to lower their cholesterol levels.

However, the majority of patients do not reach recommended cholesterol levels using only statins, and so need an add-on treatment, such as ezetimibe.

“Today’s guidelines recommend stepwise addition of lipid-lowering treatment. But it’s often the case that this escalation takes too long, it’s ineffective and patients are lost to follow-up,” says Margrét Leósdóttir, Associate Professor at Lund University and senior cardiology consultant at Skåne University Hospital in Malmö, Sweden. “By giving patients a combination treatment earlier, we could help to prevent many more heart attacks.”

Co-investigator Professor Kausik Ray, from Imperial College London’s School of Public Health, said: “This study shows that we could save lives and reduce further heart attacks by giving patients a combination of two low-cost drugs.

“But at the moment patients across the world aren’t receiving these drugs together. That’s causing unnecessary and avoidable heart attacks and deaths – and also places unnecessary costs on healthcare systems.

“Our study shows the way forward; care pathways must now change for patients after this type of heart event.”

Reducing heart attacks

In the latest study, the international team examined outcomes for heart attack patients if they received a combination of statins with the add-on therapy ezetimibe (within 12 weeks after a heart attack), statins with ezetimibe added later (between 13 weeks and 16 months), or just statins with no ezetimibe at all.

Based on Swedish registry data from 36 000 patients who had a heart attack between 2015 and 2022, the researchers used advanced statistical models to emulate a clinical trial.

The results show that patients who received a combination treatment of statins and ezetimibe within 12 weeks of a heart attack and were able to lower cholesterol to the target level early, had a better prognosis and less risk of new cardiovascular events and death than those who received the add-on treatment later, or not at all.

From the analysis, the researchers believe many new heart attacks, strokes and deaths could be prevented every year internationally if the treatment strategy were to be changed.

Under a scenario in which 100% of patients would receive ezetimibe early, they estimate 133 heart attacks could be avoided in a population of 10 000 patients in 3 years.

The researchers suggest that in the UK, which records an estimated 100 000 hospital admissions from heart attacks a year,[1] this would equate to an estimated 5000 heart attacks being prevented over a ten year period.[2]

Improving guidance

Dr Leósdóttir said: “Combination therapy is not applied up-front for two main reasons. General recommendations are not included in today’s guidelines and a precautionary principle is applied to avoid side effects and overmedication.

However, there are positive effects from applying both medicines as soon after the infarction as possible. Not doing this entails an increased risk. In addition, the drug we have examined in the study causes few side effects and is readily available and inexpensive in many countries.”

Margrét Leósdóttir hopes that the research results will in time provide support for changes in the recommendations. A treatment algorithm has already been introduced at her hospital in Sweden to help doctors to prescribe appropriate lipid-lowering treatment for patients who have had a myocardial infarction.

It has been noted that patients achieve their treatment goals earlier and two months after the infarction twice as many patients have reduced their bad cholesterol to the target level, compared with previously.

“Several other hospitals in Sweden have also adopted the algorithm and there are similar examples from other countries that have produced as good results. My hope is that even more will review their procedures, so that more patients will get the right treatment in time, and we can thereby prevent unnecessary suffering and save lives.”

Source: Imperial College London

Categories : Cancer Cardiovascular DiseaseTags :

Do Non-statin Cholesterol-lowering Drugs Affect Liver Cancer Risk?

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Like statins, cholesterol absorption inhibitors are linked with a lower risk of developing liver cancer.

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Past studies have suggested that taking cholesterol-lowering statin drugs may lower the risk of developing liver cancer. In a new study of non-statin cholesterol-lowering medications, one type was linked to lower risks of liver cancer. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

Cholesterol absorption inhibitors, bile acid sequestrants, fibrates, niacin, and omega-3 fatty acids are types of non-statin cholesterol-lowering medications prescribed to manage cholesterol and lipid levels. The different classes of drugs work in different ways. A team led by Katherine A. McGlynn, PhD, MPH, of the National Cancer Institute, looked for associations between these five types of non-statin cholesterol-lowering medications and risk of liver cancer, the sixth most commonly occurring cancer globally and the third leading cause of cancer mortality.

The investigators used information from the Clinical Practice Research Datalink (CPRD), a primary care database that covers approximately 7% of the United Kingdom population. Their analysis included 3719 liver cancer cases and 14 876 matched controls without cancer. Additional matches were also made based on individuals’ type 2 diabetes and chronic liver disease status.

Use of cholesterol absorption inhibitors was associated with 31% lower odds of liver cancer risk in the overall analysis. These medications were also linked with a lower risk of liver cancer in analyses based on diabetes and liver disease status. The study also confirmed that statins were associated with 35% lower odds of liver cancer.

No associations with liver cancer risk were observed for fibrates, omega-3 fatty acids, or niacin. While bile acid sequestrant use was associated with higher odds of liver cancer risk in the overall analysis, the results of analyses based on diabetes and liver disease status were inconsistent, suggesting that replication of these observations is important.

“As few studies have examined the effects of non-statin cholesterol-lowering drugs on liver cancer risk, the results of our study require replication in other populations. If our findings are confirmed in other studies, however, our results may inform liver cancer prevention research,” said Dr. McGlynn.

Source: Wiley