Health for life

Statin use is associated with protection from esophagus cancer according to a new meta-analysis of existing clinical studies exploring the cancer prevention effects of statins presented by a Mayo Clinic researcher, Dr. Siddharth Singh, at the American College of Gastroenterology 77th Annual Scientific Meeting in Las Vegas, NV.

Dr. Singh and his Mayo colleagues conducted a systematic review of eleven studies reporting 8,613 cases of esophageal cancer from studies including almost 1 million patients. Incidence of esophageal cancer is increasing in the United States, especially esophageal adenocarcinoma in patients with Barretts esophagus.

"The meta-analysis of these studies showed a significant 30 percent reduction in esophageal cancer incidence with statins use," said Dr. Singh.

When looking more closely at the seven highest-quality observational studies among the eleven, researchers continued to find a significant chemo-protective effect with statin use. An analysis of a subset of patients with Barretts esophagus, a pre-malignant condition associated with chronic acid lux, revealed that, in this higher risk population, statin use was associated with a significant 41 percent decrease in the risk of adenocarcinoma of the esophagus.

If the child has diabetes, is 8 years of age or older, with an LDL ≥ 130 mg/dl, yes, statins and other cholesterol-lowering drugs should be considered.

Those are the recommendations of the nutrition committee of the American Academy of Pediatrics. The new guidelines were made public last week in the Academys journal Pediatrics:

Lipid Screening and Cardiovascular Health in Childhood, July, 2008

The guidelines advise screening children, via a fasting lipid profile, "after 2 years of age but no later than 10 years of age" if they present with the following risk factors:

• Positive family history of dyslipidemia or CVD
  
• Patients for whom family history is not known
  
• Overweight or obesity
  
• Hypertension
  
• Cigarette smoking
  
• Diabetes mellitus

What is an acceptable LDL cholesterol level?

"Targets as low as 130 mg/dL or even 110 mg/dL may be warranted when there is a strong family history of CVD, especially with other risk factors including obesity, diabetes mellitus, the metabolic syndrome, and other higher-risk situations."

The prospect of an indefinite period of pharmacological intervention, beginning in childhood, may make lifestyle changes such as diet and exercise* that much more inviting.

* The guidelines recommend adherence to the USDAs Dietary Guidelines for Americans, which list recommended servings for grains, fruits, vegetables, and milk/dairy, as well as fat and calorie limits, according to age and gender. The USDA Guidelines also recommend that "children and adolescents engage in at least 60 minutes of physical activity on most, perably all, days of the week."
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If you click on the little astronaut up there, it will take you to an interactive computer game the USDA designed for children as an introduction to the food pyramid. They can "reach Planet Power by fueling their rocket with food and physical activity."

First, the negatives:

Statins may cause muscle pains:

Musculoskeletal conditions, injuries may be associated with statin use

Potency of Statins Linked to Muscle Side Effects

Research Finds Link Between Statin Use and Progressive Muscle Disease

and Diabetes:

Intensive-Dose Statin Therapy Associated With Increased Risk of Diabetes

But taking Coenzyme Q10 may eliminate or minimize these risks:

Co-Q10 deficiency may relate to statin drugs, diabetes risk

and has other benefits as well:

Coenzyme Q10 Improves Heart Failure Mortality

and the overall risk of Diabetes may be worth it:

Statins Heart Benefits Outweigh Diabetes Risk: Study

Patients taking statins who were not at risk for diabetes had a 52 percent lower risk of developing heart disease and no increased risk of developing diabetes.

Statins may cause fatigue,

Statins Shown to Cause Fatigue

depression,

Link between statin drugs and depression

and may or may not increase the risk of cataracts:

Statin Use Tied to Possible Boost in Cataract Risk

Statins cut cataract risk in men by 40%

Statins prevent cataracts

and impair memory:

Study finds link between commonly prescribed statin and memory impairment

But:

Statin medications may prevent dementia and memory loss with longer use

High dose statins prevent dementia

And to summarize:

Statins can lead to an increased risk of liver dysfunction, acute renal failure, myopathy (musclepain) and cataracts.

But:

Statin use linked to few side effects

Statins -- the popular class of cholesterol-lowering drugs used widely to prevent recurrent heart disease or stroke as well as risk for having a first cardiac or stroke event -- appear to cause few side effects, according to new research reported in Circulation: Cardiovascular Quality and Outcomes. Researchers conducted the largest meta-analysis on statin side effects to date, reviewing data from 135 previous drug studies to evaluate the safety of the seven statins on the market. They concluded "as a class, adverse events associated with statin therapy are not common."

Now the benefits


(Red Yeast Rice -may be an alternative to statins)

Statins are available over the counter in Great Britain, without a prescription. Some advocate for even wider distribution:

Free statins with fast food could neutralize heart risk, scientists say

Wider Utilization of Statins in Prevention and Treatment of Heart Attacks and Strokes?

The available data suggest that there is no threshold for low density lipoprotein cholesterol below which there are no net benefits of statins. Theore, there are new and emerging clinical challenges to healthcare providers suggesting the need for wider utilization of statins in the prevention of heart attacks and strokes.

Wider statin use could be cost-effective preventive measure

A new analysis suggests that broader statin use among adult patients may be a cost-effective way to prevent heart attack and stroke.

But others advise caution (Although Im not quite sure why after reading what they have to say:)

Statins should be prescribed with caution in those at low risk of cardiovascular disease

Combined data from eight trials involving 28,161 patients that provided data on deaths from all causes showed that statins reduced the risk of dying from 9 to 8 deaths for every 1000 people treated with statins each year. Statins reduced fatal and non-fatal events, including heart attack, stroke and revascularization surgery, as well as blood cholesterol levels. However, the researchers say that the conclusions of their review are limited by unclear, selective and potentially biased reporting and that caul consideration should be given to patients individual risk profiles before prescribing statins.

Statin RX may be overprescribed in healthy people without evidence of diseased arteries

Rolling back suggestions from previous studies, a Johns Hopkins study of 950 healthy men and women has shown that taking daily doses of a cholesterol-lowering statin medication to protect coronary arteries and ward off heart attack or stroke may not be needed for everyone.

General Benefits:

Statin Effects in Women Versus Men

Conclusions: Statin therapy is associated with significant decreases in cardiovascular events and in all-cause mortality in women and men. Statin therapy should be used in appropriate patients without regard to sex.

Coronary Heart Disease

Lowering Cholesterol Reduces Stroke, Heart Attack Risk

People whose cholesterol improved after one month on cholesterol-lowering drugs called statins reduced their risk of stroke and heart attack. For each 10-percent decrease in LDL, or low-density lipoprotein “bad” cholesterol, the risk of stroke was reduced by four percent and the risk of heart attack was reduced by seven percent. The average decrease in LDL cholesterol after one month on atorvastatin was 53 percent.

More Intensive Statin Treatment Reduces Heart Risk Further

Beginning Statin Use Earlier = three-fold greater reduction in the risk of CHD

Coronary atherosclerosis – a hardening of the arteries due to a build-up of fat and cholesterol – can lead to heart attacks and other forms of coronary heart disease (CHD). Lowering low-density lipoprotein (LDL), or "bad" cholesterol, reduces the risk of CHD, and researchers found that lowering LDL beginning early in life resulted in a three-fold greater reduction in the risk of CHD than treatment with a statin started later in life, according to research presented today at the American College of Cardiologys 61st Annual Scientific Session.

Statins Helpful, BUT Take Time To Work

Over the long term, treatment with cholesterol-lowering statins reduces the rate of mortality and cardiovascular events such as heart attack, for people with and without heart disease. Still, it is unclear whether these drugs take effect rapidly when the risk of these dire events is highest. A systematic review of randomized controlled trials found that death, stroke and heart attack did not decline significantly in the first few months after starting the drugs, but indicated that statins might reduce the likelihood of severe chest pain during this period and are quite safe in any case. Adverse effects were “very rare” in both statin and control groups, Briel said. Signs of muscle damage—the most severe risk of statin therapy—were limited to patients in a single study who received a particular statin, simvastatin, at a dosage known to carry a relatively high risk of this side effect.

Statins reduce CV events in CAD patients with very low LDL-C

Statins accelerate depletion of plaque in arteries

Statins: Reduced Risk of Recurrent Cardiovascular Events in Men, Women


Most At-Risk Patients Don’t Adhere To Statin Treatment, Despite Real Benefits

A new study from North Carolina State University shows that the vast majority of patients at high risk for heart disease or stroke do a poor job of taking statins as prescribed. That’s especially unfortunate, because the same study shows that taking statins can significantly increase the quality and length of those patients’ lives.

“We found that only 48 percent of patients who have been prescribed statins are taking their prescribed dose on a regular basis after one year – and that number dips to approximately 27 percent after 10 years,” says Jennifer Mason, a Ph.D. student at NC State and lead author of a paper describing the study. Statins are a component of many current cardiovascular medical treatment guidelines. They lower cholesterol levels and may significantly reduce the risk of heart attack and stroke, particularly in patients that are considered to be at high risk.

The researchers also found that, for high-risk patients, high adherence to a prescribed statin regimen may increase quality-adjusted life years (QALYs) by as much as 1.5 years compared to low adherence – and up to two years compared to not taking statins at all. Low adherence means a patient is taking the statins irregularly or at less than the prescribed dosage. QALYs are established metrics for measuring the effect of health conditions, such as heart disease and stroke, on quality of life.

Cancer:

Statins Tied To Reduced Cancer Deaths

A new study from Denmark found that people who regularly used statins to lower cholesterol and then received a cancer diagnosis were 15% less likely to die from cancer or any other cause than cancer patients who had never used statins.

Statins may protect against esophageal cancer

Men who take statins are less likely to die from prostate cancer


Statin and Aspirin Use Linked to Improved Survival in Women with Endometrial Cancer


Statins = improved survival in inflammatory breast cancer

Statin use associated with statistically significant reduction in colorectal cancer

Statins associated with lower cancer recurrence following prostatectomy

Low Cholesterol=Lower Prostate Cancer Risk


Statins Can Help Prevent Skin Cancer

Two large cardiovascular clinical trials have demonstrated a significant reduction in skin cancer among patients taking lipid-lowering drugs. Although clinical data do not consistently show a decreased risk of skin cancer with statin use, various human trials and preclinical studies suggest that statins may have chemopreventive activity against skin cancer.

Other Specific Benefits:

Benefits of statin therapy include eliminating blood clots as well as lowering lipids

Pneumonia Death Rate Lower Among People Who Take Statins

Reduced glaucoma risk in patients who take statins

Statin significantly reduces lung damage in severe abdominal sepsis


Statin therapy associated with lower risk of pancreatitis

Statin use appears associated with modest reduction in Parkinsons disease risk

Statins = reduced mortality in flu patients

Statins May Boost Your Gums Health, Too


Statins may prevent pneumonia

Statins may slow human aging


Statins may slow prostate growth

Statins reduce deaths from infection and respiratory illness

Those taking statins when admitted to the hospital with serious head injuries were 76 percent more likely to survive

Chronic Statin Therapy Associated With Reduced Postoperative Mortality

Cholesterol-lowering statins boost bacteria-killing cells

Regular statin use is associated with a reduced risk of developing rheumatoid arthritis


Statins decrease risk of clot-related diseases

Statins may slow progression of multiple sclerosis

Statins fight gallstones

More Evidence Statins Fight Parkinsons

Statin drugs may have a protective effect in the prevention of liver cancer and lead to a reduction in the need for gallbladder removals

Statins can protect against Alzheimers disease


Statins reduce loss of lung function, keeping old lungs young - even in smokers

Statin Use Benefits Multiple Areas of Urologic Health

People who exercise along with taking statins to lower their high cholesterol levels can dramatically reduce their risk of dying, a large new study suggests.

"The reduction in death is independent; whatever statins do is independent of what exercise does," said lead researcher Peter Kokkinos, a professor in the cardiology department at the Veterans Affairs Medical Center in Washington, D.C.

"When you combine the two, you get even better results," he said. "If you are taking statins, your mortality is about 35 percent lower versus not taking statins, but if you exercise, your mortality level decreases as your fitness level increases to the point where you can reach a 70 percent reduction in mortality."

Kokkinos is talking about regular moderate exercise -- not vigorous workouts. "Thirty minutes a day of brisk walking -- not a whole lot," he said.

Statin drugs include Lipitor (atorvastatin), Lescol (fluvastatin), Pravachol (pravastatin), Crestor (rosuvastatin) and Zocor (simvastatin).

Some people cant take statins because of side effects, Kokkinos said. "For these people, exercise alone reduces your risk just as much, if not more, than statins," he said. However, he stressed, "we do not recommend that people do not take their statins."

Exercise works by stressing the body making it stronger, Kokkinos said. Its an evolutionary adaptation to protect the body from being overcome by changing stressors, he said.

"Get off the couch -- walk," Kokkinos said. "About 150 minutes a week of brisk walking is all you need."

The report was published online in the Nov. 28, 2012 edition of The Lancet.

For the study, Kokkinos team analyzed the medical records of more than 10,000 veterans with high cholesterol levels treated in Veterans Affairs hospitals in Washington D.C., and Palo Alto, Calif. Of these, 9,700 were men and 343 were women.

The researchers judged the fitness levels of the participants by looking at the results of standard treadmill exercise tolerance tests, which were given between 1986 and 2011.

Fewer deaths occurred among participants who were taking statins and were physically fit. Over 10 years of follow-up, those who were the most physically fit had the lowest risk of dying, the researchers noted.

These fittest people actually reduced their risk of dying by about 60 percent regardless of whether they were taking statins, according to the study.

These difference in death risk could not be explained by age, weight, ethnicity, gender, history of cardiovascular disease, risk factors for cardiovascular disease or medications, the researchers said.

According to the U.S. Centers for Disease Control and Prevention, about 71 million Americans have high cholesterol, which is an important risk factor for heart disease, the authors pointed out.

One expert familiar with the new findings cautioned that exercise is not a replacement for statins in those with high cholesterol. The best results are among those taking statins and who are the fittest, he emphasized.

"Cardiovascular disease remains the leading cause of death and disability in men and women in the United States," said Dr. Gregg Fonarow, a spokesman for the American Heart Association and a professor of cardiology at the University of California, Los Angeles.

"Statin therapy has been proven in multiple clinical trials to substantially reduce cardiovascular events and all-cause mortality in men and women with or at risk for cardiovascular disease," he said.

Some people have assumed that if they are engaging in regular exercise and are physically fit that they may not benefit from statin treatment and some physicians consider statin therapy only for patients who have failed attempts at lifestyle modification, Fonarow said.

This new study shows that at all levels of physical fitness, statin therapy was independently associated with lower risk of dying. The very best 10-year outcomes were among men and women taking statins with the highest fitness levels, he noted.

"These findings further reinforce the remarkable real-world clinical effectiveness and safety of statin therapy to prevent and treat cardiovascular disease," Fonarow said.

Statins lower the rate of cataract by 20 percent, according to research presented at the ESC Congress today by Professor John B. Kostis from New Jersey, USA. The risk of cataract was reduced by 50 percent when treatment was initiated in younger individuals (in their 40s) and the duration of therapy was longer (e.g. up to 14 years).

Cataracts are the leading cause of visual impairment worldwide affecting more than 20 million people. Statins are among the most commonly prescribed medications. In the USA they are prescribed to 1 in 3 people over 45 years of age at a cost of $35 billion annually.

Professor Kostis said: "There is persistent concern among physicians and other health care providers about the possible cataractogenicity of statins.1 We theore investigated the relationship of statins and cataracts in a meta-analysis of 14 studies selected after detailed review of the medical literature. To our knowledge this is the first meta-analysis on the topic."

The meta-analysis included 2,399,200 persons and 25,618 cataracts. The average duration of treatment was 54 months and average age was 61.

Using random effects meta-analysis, a statistically significant decrease in cataracts with statins was observed (odds ratios [OR] 0.80, 95% confidence interval [CI] 0.77-0.83, p<0.0001). Professor Kostis said: "This corresponds to an approximately 20% lower rate of cataracts with statin use compared to no statin use."

Absolute risk reduction was 1.4%+0.015% (95% CI 1.1%-1.7%, p<0.0001). Professor Kostis said: "This equates to 71 persons needed to treat (NNT) with statins to prevent one cataract (95% CI 59-91 persons)."

Meta-regression showed that younger people were more likely to benefit, with an OR of 0.50 for patients in their 40s and an OR of 0.90 for patients in their 70s. Professor Kostis said: "Our analysis shows that people in their 40s who use statins have a 50% lower chance of getting cataracts. For people in their 70s risk is lowered by just 10%. It is possible that the two processes (aging and statins) work in parallel or interactively."

The analysis showed an increase in benefit of statins with longer duration of treatment with the OR varying from 0.90 for a treatment duration of 6 months (a 10% reduction in risk) to 0.45 for a treatment duration of 14 years (a 55% reduction in risk).

There was no difference between studies by gender. Several sensitivity analyses confirmed the results.

Professor Kostis concluded: "This meta-analysis indicates a statistically significant and clinically relevant protective effect of statins in preventing cataracts. The effect is more pronounced in younger patients, and with longer use. Our findings dispel worries about the safety of statins when it comes to cataracts, and lends additional support to long term statin use."

Figure notes:

Extraction: Studies pertaining to removal of cataract by an operation; No Extraction: Studies where removal of cataract by an operation was not the endpoint; Clinical: Studies where the patient or a physician reported the presence of cataract; Opacities: Studies where an ophthalmologist reported the presence small areas of cloudiness in the lens of the eye unrelated to visual complaints by the patients.

People who take statins to reduce their risk of cardiovascular disease are less likely to be diagnosed with the most common form of glaucoma, according to a nationwide study of more than 300,000 patients. A University of Michigan School of Medicine research team, directed by Joshua Stein, MD, MS, found that the risk for glaucoma was reduced by eight percent in patients who took statins continuously for two years, compared with patients who did not take statins. The study, the largest to date on the topic, is published in the October issue of Ophthalmology, the journal of the American Academy of Ophthalmology.

Dr. Steins study was sparked by growing evidence that statin use may protect the optic nerve and retinal nerve fibers, structures that are essential to good vision and are damaged by glaucoma. His team used healthcare claims data for a diverse population of Americans aged 60 and older who took statins to control high blood levels of unhealthy fats, a condition known as hyperlipidemia, between 2001 and 2009, The researchers assessed patients risk for open-angle glaucoma (OAG). Unlike earlier studies, their analysis adjusted for patients who also had diabetes and/or hypertension to prevent distortion of the results.

Several of the studys findings suggest that statin use may be most important before glaucoma is diagnosed, or in the early stages of the disease. Dr. Steins research may lead to new preventive treatments that could especially benefit groups at increased risk, including African-Americans, Hispanics and those with a family history of glaucoma.

Glaucoma affects more than 2.7 million Americans age 40 and older . If untreated, glaucoma causes vision loss or blindness by damaging the eyes optic nerve. The optic nerve sends signals from the retina — a layer of light-sensitive tissue at the back of the eye — to the brain, where these signals are interpreted as the images we see. Only about half of the people who have glaucoma know it, since symptoms are rarely noticed in the early stages and vision loss is very gradual in most cases.

"Statins apparent ability to reduce glaucoma risk may be due to several factors, including improved blood flow to the optic nerve and retinal nerve cells and enhanced outflow of the aqueous fluid, which may reduce intraocular pressure," said Dr. Stein. "While more research is needed, we hope our results may contribute to saving the sight of thousands who are predisposed to glaucoma."

Dr. Stein cautioned that the study results apply only to patients with hyperlipidemia, and that further study is needed to determine whether statins also protect patients who dont have this diagnosis or have other characteristics that differ from the study population.

A new study from Denmark found that people who regularly used statins to lower cholesterol and then received a cancer diagnosis were 15% less likely to die from cancer or any other cause than cancer patients who had never used statins.

Statins are the most commonly prescribed drug for lowering cholesterol and reducing the risk of heart disease.

The researchers, from the University of Copenhagen, write about their findings in the 8 November early online issue of the New England Journal of Medicine.

They decided to look at the link between statin use and cancer death because, as cholesterol is necessary for cell growth, it has been suggested that reducing it may limit the cellular proliferation required for cancer growth and spread.

They did not look at whether taking statins affected peoples risk for developing cancer.

For the study, the researchers used Danish national databases to find all patients who had received a diagnosis of cancer between 1995 and 2007, with follow-up until end of 2009.

This yielded data on a total of 295,925 patients aged 40 and over, of whom 18,721 had used statins regularly before their cancer diagnosis and 277,204 had never used statins.

When they analyzed the data statistically using hazard ratios, the researchers found among patients who had regularly taken statins, deaths from cancer were reduced by 15%, as were deaths from all causes.

Eric Jacobs, Strategic Director of Pharmacoepidemiology at the American Cancer Society, says in a statement about the study that while the findings are "exciting":

"... it does not mean people with cancer should start using statins in the hopes of improving their progress."

He says other factors could be behind the lowered rates of death. For example, it may be that some of the people taking statins could also have been taking aspirin, which some studies published recently have linked to improved survival from cancer (in August 2012 Jacobs and his team carried out a review of such evidence).

Jacobs also points out that randomized trials of people taking statins to reduced risk of developing heart disease did not show benefits against cancer - and yet they should have, according to the findings from this Danish study.

He suggests further research is now needed to "clarify if and how statins might influence survival in cancer patients".

The statin medications you take for your heart may have an unexpected side benefit: They help reduce inflammation of the gums, according to new research.

Using advanced imaging techniques, researchers were able to see that when people with gum disease took higher doses of the commonly prescribed cholesterol-lowering drugs, their gum inflammation decreased.

During the 12-week study, the researchers also looked for evidence of inflammation or hardening of the blood vessels (atherosclerotic disease) in the study volunteers, and they found that reduced gum inflammation was correlated with improved blood vessel health.

"There is a building, growing body of literature that draws a line between gum disease and atherosclerotic disease. In our study, benefits in the gums correlated with benefits in the arteries," said the studys senior author, Dr. Ahmed Tawakol, co-director of the Cardiac Imaging Trials Program at Massachusetts General Hospital and Harvard Medical School in Boston. "People with [gum disease] and atherosclerotic disease should likely be that much more vigilant in treating their gum disease."

The study was published online Oct. 2 in the Journal of the American College of Cardiology. Funding was provided by drug manufacturer Merck and Co., which does not produce the statin used in this study.

Currently, statins are prescribed to lower high levels of "bad" cholesterol, also known as LDL cholesterol. When theres too much LDL cholesterol, it can start to build up on blood vessel walls, leading to hardening of the arteries.

In the United States, more than 30 million people take statins, and as many as 200 million people worldwide take these cholesterol-lowering medications, according to a journal editorial accompanying the study. Periodontal disease (or gum disease) affects nearly half of U.S. adults.

According to editorial author Dr. Michael Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore, a "consistent stream of data" shows that statins have benefits beyond their cholesterol-lowering properties.

"There are three big categories of how statins likely exert their effects: lowering LDL, reducing inflammation, and by modulating plaque," said Blaha.

The current study lends support to the idea that statins can reduce inflammation. It included 83 adults who had risk factors for, or already had, atherosclerosis. They were randomly assigned to take either 10 or 80 milligrams of a statin called atorvastatin (brand name Lipitor) for three months.

Everyone underwent imaging at the start of the study, again after four weeks and then at 12 weeks.

At the end of the study, the investigators had complete data on 59 people. They found a significant reduction in gum inflammation for the people taking 80 mg of atorvastatin compared to those on the 10-mg dose. Changes began as early as four weeks after people started taking the higher-dose drug.

There was a more significant reduction in gum inflammation for people who had more serious gum disease at the start of the study and took a higher dose of the statin. The researchers also found that a reduction in gum inflammation correlated with reduced blood vessel inflammation.

"It was really those on the higher-dose statins that had the benefit," noted Tawakol. But, "I would not recommend the use of statins outside the current guidelines," he added. "We see this trial more as a proof-of-principle trial. Our findings need to be confirmed in a larger clinical trial."

Still, he said, theres little harm in telling people to take care of gum disease. "Patients with known heart disease and known gum disease should have their gum disease evaluated and treated," Tawakol said.

Blaha agreed that its too soon to change practice guidelines either for treating heart disease risk factors or for gum disease.

Still, "this study and others like it have tremendous implications," Blaha said. "Weve never had a drug that worked this well and for so many different groups of patients."