Should I take statins as a preventive measure?

A new Cochrane systematic review conducted by London School of Hygiene and Tropical Medicine and the University of Bristol questioned the benefits of prescribing statins to people without heart disease.

Researchers reviewed 14 trials involving more than 34,000 patients with low risk of heart attack and strokes. They found that overall statins reduced mortality, but the effect was very small - 1000 people have to be treated for 1 year to prevent 1 death. Previous studies have found that statins have been associated with a range of side effects including kidney failure and muscle weakness, therfore not worth the risk in people without history of cardiovascular disease.

They pointed out that the findings of the trials were biased due to several shortcomings: 1/3 of the trials outcomes were selectively reported, 8 trials did not report on the adverse effects, 2 large trials were stopped prematurely, only 1 trial has been funded publicly while 9 trials were sponsored by drug companies partially or fully. They concluded "widespread use of statins in people at low risk of cardiovascular events ..... is not supported by the existing evidence".

Oxford researchers noted that the Cochrane review did not include the recent meta-analysis conducted by the Oxford group which was more reliable than the Cochrane review.

In an accompanying editorial, the author said that the current evidence supports the NICE guidance that statins should be used for the primary prevention of CVD for people with more than 20% risk of developing the disease. Given the limitations of the study, he suggested an alternative approach to focus on population-wide prevention.

Source:

Taylor F, Ward K, Moore THM et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2011, Issue

Editorial :Considerable uncertainty remains in the evidence for primary prevention of cardiovascular disease. Cochrane Library 2011, (January 19, 2011).

http://www2.cochrane.org/reviews/en/ab004816.html

Could stronger statins save lives?

Statin is one of the world's biggest selling drug for lowering LDL cholesterol, a new research suggests using more potent doses of statin could prevent thousands more heart attacks and strokes.


40,000 high-risk patients were assessed for major vascular events after one year of randomisation to either regular or intensive treatment statin. The results, published in The Lancet, found that stronger treatments reduced major heart attacks and strokes by 15%. This included a 13% cut in heart-related death or non-fatal heart attacks, a 19% drop in bypass and other coronary treatments, and a 16% drop in strokes.

However, the study warned that simply raising the dose of simvastain might lead to health problem as muscle weakness and muscle damage are some of the known side effects.

Source: "Intensive lowering of LDL cholesterol with 80 mg versus 20 mg simvastatin daily in 12 064 survivors of myocardial infarction: a double-blind randomised trial". The Lancet, Early Online Publication, 9 November 2010 (full text via Athens)

Does statin use reduce prostate cancer recurrence?

Statins is a common treatment to lower cholesterol but a study, published online in June 28 in Cancer, found that men taking statins before their prostate surgery were less likely to show signs of the cancer recurring.

The study reviewed the data of 1319 men who had prostatectomy and took statins when they had their operation and showed that they had a 30% lower risk of PSA recurrence compared to those not taking statins. The greater the dose of statins taken, the less likely the cancer was to reappear.

The researchers said if other studies support their findings, a RCT of statins is warranted. However, critics say that the statin users differed significantly from non-users at presentation, eg they were older and had higher BMI that might affect the association between the statin use and risk for biochemical recurrence, also previous studies had mixed findings.

Another study, published in the Journal of Clinical Oncology, with 691 men underwent radiotherapy, showed a significant association between statin use and decreased biochemical recurrence.

Source:
1). Hamilton RJ, Banez LL, Aronson WJ et al. "Results from the Shared Equal Access Regional Cancer Hospital (SEARCH) Database". Cancer, [Early online publication] June 28 2010

2). "Statin Use and Risk of Prostate Cancer Recurrence in Men Treated With Radiation Therapy". Journal of Clinical Oncology, Vol 28, No 16 (June 1), 2010: pp. 2653-2659
Early Release 10.1200/JCO.2009.27.3003 on April 26 2010

Statins side effects quantified

A new study, published in the BMJ, to quantify the unintended effects of statins according to type, dose, and duration of use found that statin use was associated with increased risks of serious liver dysfunction, acute renal failure, moderate or serious myopathy ( muscle weakness) and cataracts.

Researchers examined the medical records of over 2 million patients who registered at GP practices in England and Wales, the patients were monitored over a period of 6 years. They found that Simvastatin was the most prescribed statin and the side effects are already known. Eestimates of the absolute risks were also provided : for 10,000 people, there would be 17 extra cases of kidney failure, 252 cataracts, 65 liver problems and 32 myopathy. The adverse effects were similar across the statin types for each outcome except liver dysfunction where fluvastatin was associated with the highest risks.

The accompanying editorial says that the benefits of statins seem to outweigh the risks. It is suggested that patients should not change their medication.

Source: Hippisley-Cox J, and C Coupland. Unintended effects of statins in men and women in England and Wales: population based cohort study using the QResearch database. BMJ 2010;340:c2197 ( f/t via Athens)

Statins raise small diabetes risk

Statins have been used as cholesterol-lowering drugs to prevent heart attacks and strokes although trials of statins have produced conflicting results.

A new report based on a meta-analysis of 13 randomised controlled trials of statins between 1994 and 2009 involving 91,000 patients showed that there was a clear link between statin treatment and a small but significant increased risk of diabetes - 9% increase over 4 years in those using the drug than those without the treatment. The researchers said that the risk is very low and outweighed by the benefits of this drug and concluded that patients with moderate or high cardiovascular risk should not stop taking this drug.

Critics say this is a well-conducted review, when all the results were combined into a meta-analysis, the diabetes risk was relatively small, however various unidentified cofounding factors may have affected the observed results. The study was published in The Lancet online.

Source: "Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials". The Lancet, Early Online Publication, 17 February 2010

Statins lower prostate cancer risk?

Rising blood levels of PSA (prostate-specific antigen) is used to diagnose prostate cancer, but there is conflicting evidence that statins ( cholesterol-lowering drug) may be associated with a reduced risk of prostate cancer.


Researchers at Duke University studied changes in PSA levels in 1,214 men who were prescribed statins and found PSA level drops slightly in men who lower their cholestrol with statin drugs. They said that the reduction could mean that statins may affect prostate biology or statins may lower their PSA levels without lowering the risk of prostate cancer, making the disease more difficult to diagnose.


Critics said further research is needed and men who currently take Statins should not be worried by these findings. In the UK, PSA testing is not rountinely carried out.


Source: Hamilton RJ, Goldberg KC, Platz EA, Freedland SJ. The Influence of Statin Medications on Prostate-specific Antigen Levels. Journal of the National Cancer Institute 2008; Advance Access published online on October 28, 2008

Statins may also reduce blood pressure

The Telegraph reported a randomized, double-blind, placebo-controlled trial involving 973 men and women who did not have high blood pressure and cardiovascular disease. Researchers found that two types of statins - simvastatin and pravastatin, modestly but significantly reduced blood pressure of the group compared with the placebo. The reductions ranged from 2.4 to 2.8 mm Hg for both SBP and DBP.

The researchers said that these reductions "may contribute to the reduced risk of stroke and cardiovascular events reported on statins", but critics said it is not possible to say whether statins have similar effects in people with high blood pressure.

Source: "Reduction in Blood Pressure With Statins - Results From the UCSD Statin Study, a Randomized Trial" Archive of Internal Medicine. 2008;168(7):721-727.

Extended benefits of statin therapy

A 15-year Glasgow study showed that patients who had been taking pravastatin for 5 years were still experiencing the benefits 10 years after they stopped taking the drug, with a significant reduced risk of heart attacks and other coronary events.


The extended benefits may be due to the lowering LDL cholesterol by early statin therapy and stabilizing existing plague therefore slowing the progress of coronary heart disease.


Source : "Long-Term Follow-up of the West of Scotland Coronary Prevention Study". NEJM 2007; 357(15):1477-1486 (October 11)

Rethink preventive treatments in elderly people

Researchers from the UK and New Zealand said that "preventive treatments in elderly people may simply change the cause of death rather than prolonging life" in the article "Preventive health care in elderly people needs rethinking" in BMJ Online First.


As an example, they said that elderly patients will not necessarily reduce their risk of death caused by cardiovascular disease if they are given statins, their cause of death will most likely be "substituted" for cancer. Doctors are given financial incentives to persuading patients to accept such preventive treatments that are expensive and can be harmful to them.


The authors called for a more sophisticated model to assess preventive treatments in the elderly and concluded that cash may be better spent in relieving suffering through cataract, joint replacement operations and caring for people with dementia.

Statin delays artery damage in FH children

According to a randomised, double-blinded, placebo-controlled study in the Netherlands, statin therapy is safe and effective in treating children with familial hypercholesterolemia ( FH ), researchers found that early initiation of statin treatment in FH children as young as 8 delays the early artery damage.

214 children of 8 - 18 were randomised to receive treatment with pravastatin 20 or 40 mg depending on their age or placebo for 2 years.

Follow-up data for 186 children with an average of treatment period of 4.5 years showed that earlier initiation of statin treatment results in a smaller carotid artery intima-media thickness (IMT) at a later age. Furthermore, no serious clinical or laboratory adverse events were reported.

The results showed that the age of statin initiation was a strong, independent predictor for the increased thickening between the intima and media, however, the researchers suggested further clinical trials will be required to determine the optimal age for beginning statin therapy in FH children.

The study "Statin Treatment in Children With Familial Hypercholesterolemia: The Younger, the Better" is published in the journal Circulation. 2007; 116: 664-668

Low cholesterol linked to cancer risk

Statins are the world's top-selling drugs in lowering cholesterol to reduce the risk of heart disease, but a new meta-analysis that examined more than 4o,ooo patient records in 23 different trials of statins found that low cholesterol increased cancer risk although the study did not show that the statin drugs themselves caused the cancer.

The reserachers said their findings support taking multiple medications rather than high-dose statins to minimize the side effects and emphasized that patients should continue their statins treatments. The study is published in the July 31, 2007 issue of the Journal of the American College of Cardiology (JACC) 2007, 50:419-420.

In an accompanying editorial, John C. LaRosa said "these current findings provide insufficient evidence that there is any problem with LDL lowering that outweighs its significant benefits on vascular disease." Read the press release.