Cholesterol Watch

Pharmacy TimesOctober 2009
Volume 75
Issue 10

Many Who Should Take Statins Do Not

Statins are not being taken by nearly half of the Americans who meet the criteria for these medicines, found a national survey presented at a recent American Heart Association meeting. The findings are based on data from the 2003-2004 National Health and Nutrition Examination Survey. The researchers used the data to identify 777 adults who met the criteria established by the National Cholesterol Education Program for statin therapy. These criteria consider blood levels of low-density lipoprotein cholesterol levels and other risk factors for heart disease, such as high blood pressure and smoking. Of 777 patients, only 428 were taking statins. Overall, 44.9% of individuals who met criteria for cholesterol-lowering drug treatment were untreated. Individuals who reported being informed they had high cholesterol and had a history of heart disease were more apt to take the medications, according to researcher Erica S. Spatz, MD. The major factors linked with being untreated were: • Individuals younger than 50 years of age were twice as likely to be untreated. • Individuals with no health insurance were more than twice as likely to be untreated. • Individuals not having a source of regular medical care were nearly 4 times as likely to be untreated.

Prevent Dementia: Not with Statin Therapy Statins do not ward off Alzheimer’s disease or dementia, according to a recent report in the Cochrane Database of Systematic Reviews. In an earlier review, 2 clinical reports had found an association between statin therapy and a reduction in the frequency of Alzheimer’s disease by as much as 70%. No randomized clinical trials, however, had been performed at this point. In the current study, the researchers identified 2 published trials involving 26,340 participants. One trial compared simvastatin 40 mg with placebo, and the second trial compared pravastatin 40 mg with placebo. The researchers noted no major differences between any of the treatment groups in the percentage of participants classified as cognitively impaired. “In late life, there is good evidence that statins given to people at vascular risk have no effect in preventing Alzheimer’s disease or dementia,” explained Bernadette McGuinness, MD. “Statins cannot be recommended for this purpose therefore.”

New Cholesterol Tests Need Further Scrutiny

Physicians may one day be able to predict which patients will develop heart disease with new tests that measure individual particles of low-density lipoprotein (LDL; “bad”) cholesterol. The researchers noted, however, that the tests still need further analysis. Although several companies have developed more refined tests that measure the size and concentration of individual LDL particles, clinicians believe that smaller LDL particles are more dangerous because they can easily become embedded in artery walls, forming clots that may break off and result in a heart attack or stroke. The researchers looked at data from 24 published studies that found an association between LDL particle concentrations and heart disease. The researchers found that in all the studies, the higher the LDL particle number, the greater the risk for heart disease, despite the levels of other fats, according to a recent issue of the Annals of Internal Medicine.

HDL May Shield Against MS Disability

Presenting at the American Academy of Neurology’s annual meeting in April, researchers reported that elevated levels of high-density lipoprotein (HDL; “good”) cholesterol may help prevent disabilities related to multiple sclerosis (MS). Because HDL has anti-inflammatory properties, it might benefit patients with the central nervous system disease. The current study, which included 186 patients with MS whose average age was 50 years, analyzed clinical demographic and HDL data. At study onset, nearly 20% of the participants had low HDL levels, whereas nearly 50% had high levels. During the next 6 years, the researchers noted that an association between the level of HDL cholesterol and the level of disability became apparent. The patients with higher scores on the Expanded Disability Severity Scale (EDSS) initially were considerably less prone to have elevated levels of HDL at follow-up. The researchers recommended that patients with MS have their HDL levels checked. If they are low, “consider dietary and medical interventions, such as statins and fish oil supplements, which are known to increase HDL levels.” The investigators concluded that further study of the relationship between HDL levels and disease progression is warranted.

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