Should more people be taking cholesterol-boosting statins?

Statins are the most commonly prescribed type of medicine within the UK, taken by millions of people to help lower their ‘bad’ low-density lipoprotein (LDL) cholesterol levels in the blood.

A large proportion of people may only be prescribed statins on the basis of their future risk though, for instance if there is a chance of the person developing cardiovascular disease, if there is a strong family history of cardiovascular disease, or determined by the person’s age.

However, experts have warned that this is simply excluding a great number of people who may benefit from taking statins, which include atorvastatin, rosuvastatin, pravastatin and more. The warnings came as part of a study published in the American Heart Association’s journal, Circulation.

Scientists based at the McGill University Health Centre (MUHC) in Montreal, Canada, argue that actually younger people with high cholesterol levels should be prescribed too. They estimated that there at least 9.5 million lower-risk, young people who would benefit from statins that aren’t taking them at the moment.

Dr George Thanassoulis, director of preventative and genomic cardiology at MUHC, said: “Targeting statin treatment to this group would prevent an additional 266,000 heart attacks and strokes over 10 years.”

In determining who they thought would receive health benefits from statin therapy, the scientists studied data from 2,134 participants of the National Health and Nutrition Examination Survey, a nationally-representative US cohort that spanned from 2005 to 2010.

The survey comprised of around 71.8 million Americans who were deemed eligible for statins. Those involved in the study then used a 10-year risk based approach, in addition to an individualised benefit approach, comparing the two different ways of looking at eligibility for statins.

Dr Thanassoulis commented: “Using a benefit-based approach, we identified 9.5 million lower-risk Americans not currently eligible for statin treatment, who had the same or greater expected benefit from statins as higher-risk individuals.

“These individuals were lower-risk because they were younger but they also had higher levels of low-density lipoprotein cholesterol which we have known to be an important cause of heart disease.”
The study’s findings may lead to health professionals reconsidering who should be prescribed the cholesterol-boosting drugs, and possibly recommending that people previously thought of as too young to be at risk of a heart attack, should be eligible for them.

Dr Thanassoulis said: “Our analysis shows that they would benefit from treatment, even in the short term, and therefore should be eligible for statin treatment.”

The scientists involved in the study argue that this could help to prevent a large number of people suffering with cardiovascular disease in the future.

“For too many, the present approach starts too late; an earlier start will multiply the lives save,” Dr Thanassoulis added.

The next step for the team that undertook the study will be the creation of a web interface to enable other physicians to take advantage of the new calculation model, and hope their method will result in new guidelines being set on identifying people who could benefit from statins.

Quit smoking for 15 years…and it could be like you had never smoked!

All smokers take note: new research has shown that those successfully quit smoking for a sustained period of 15 years, can massively decrease the chance of suffering with heart failure or even dying.

U.S. Scientists made the remarkable discovery that people who stopped smoking almost two decades previously, had a comparable risk to those that had never smoked before.

Despite the findings clearly being a positive for all smokers across the globe, heavier smokers – i.e. those that had gone through at least a packet of cigarettes each day for 32 years or more – still had a slightly increased risk of health problems.

However, lead researcher Dr Ali Ahmed, from the Washington DC VA Medical Center, is pretty clear with the message…people either need to cut down on their smoking, stop smoking as early as they can, or simply never start smoking.

He commented: “While all individuals who quit smoking will benefit from a decreased chance of death, to achieve the full complement of health benefits of smoking cessation of one who has never smoked, smokers need to smoke less and quit early, and for those are not smokers – never start smoking.”

The findings were extracted via the most recent data from the Cardiovascular Health Study, which comprised of 2,556 people that had claimed to never smoked, 629 present smokers and 1,297 previous smokers. Every participant in the study was aged 65 or over, and 312 of the previous smokers admitted to heavy cigarette usage – smoking at least one pack daily for 32 years or more.

After a 13 year follow-up evaluation, the proportion of never smokers and previous smokers who had suffered heart failure, was found to be 21% in both groups. Within the group of former smokers that had consumed one pack per day for at least 32 years, nearly 30% suffered heart failure.

Comparison of mortality risks among present smokers and heavy smokers to never smokers was an interesting find. Researchers accounted for factors such as age, sex, race, education, other health conditions and medications, discovering that present smokers were around twice more likely to die from other diseases in comparison to those that had never smoked, and previous smokers were found to be 26% more likely to die compared to the never smokers.

Dr Ahmed told Reuters: “When one smokes, it induces atherosclerosis, or the buildup of plaque in the arteries. However, when one quits smoking, the buildup of plaque and risk of blood of clots decreases, allowing one’s cardiovascular risk to return to normal over time.”

Atherosclerosis is the medical term used when a person’s arteries have become narrower and harderned, usually caused by a high level of ‘bad’ low-density lipoprotein (LDL) cholesterol.
Statins like atorvastatin (Lipitor) and rosuvastatin (Crestor) are currently taken by around 7 million people in Britain, and work to decrease rates of LDL cholesterol by reducing the production of LDL cholesterol inside the liver. It is dangerous to have high rates of LDL cholesterol as this causes the atherosclerosis, resulting in a higher risk of heart attack, stroke and coronary heart disease.

Millions more to be eligible for cholesterol-boosting statins

The threshold for those eligible to take cholesterol-lowering statins has been drastically cut by medicines regulator the National Institute of Health and Care Excellence (NICE), meaning millions more adults in England, Wales and Northern Ireland will now be offered statins by doctors.

Under controversial guidelines from the watchdog, most men aged over 60 and women over 65 will now be advised to take statins such as Atorvastatin, Pravastatin or Rosuvastatin. This will be the case even if they are only at a one in 10 risk of developing cardiovascular disease. The current threshold is 20%.

NICE say the recommendation to take statins to an extra 4.5 million adults is necessary to avoid “a tragedy waiting to happen” by decreasing the numbers of people suffering with heart attacks and strokes.

Around 12.5 million people are currently eligible for the drugs, and the NHS could see costs of an extra £52 million annually from the extra 4.5 million patients being offered statin medication. Due to decreasing costs for the drugs, the total NHS bill for statins would actually still be less than what it was in 2012.

Speaking yesterday, the NICE guidance panel argued the recommendations were devised from the “biggest ever clinical trial” and that 50,000 lives could be saved each year if those now eligible regularly took statins.

However, that indeed could be one major stumbling block – getting patients to keep taking their treatment. NICE admit that statin uptake only stands at around 60% usually, and that benefits to be gained are more likely to be 4,000 lives saved each year in addition to 22,000 strokes and heart attacks averted.

One in three deaths in the UK are the result of cardiovascular disease. It is for this reason why statins remain the most prescribed type of medication on the NHS, with Medical Specialists™ Pharmacy also seeing massive amounts of patients requesting statins to help lower their ‘bad’ LDL cholesterol, whilst raising the ‘good’ HDL cholesterol!

Although some doctors have claimed the new guidelines for statins are primarily based on studies funded by the pharmaceutical industry, this has been quickly refuted by NICE.

Professor Mark Baker, director of the Centre for Clinical Practice at NICE, blasted that such claims were “ludicrous”.

“Nobody gets onto our guideline groups if they have any significant vested interest, especially a financial interest,” he commented. “Statins are safe and effective and it is a good deal for more people to have access to them under the NHS.”

Professor Peter Weissberg, the medical director at the British Heart Foundation, stressed the importance of positive lifestyle choices in lowering the risk of cardiovascular disease. He said: “Doctors will now be able to offer a statin to people at a lower risk, but their prescription is not mandated.

“Just as important is the emphasis on trying lifestyle changes before considering treatments with drugs.”

For example, lifestyle changes hinted at by Professor Weissberg include: quitting smoking, maintain a healthy weight, exercise regularly, consume alcohol only in moderation, manage stress levels better, have a diet rich in fruit and vegetables/limited in trans fats and keep your blood pressure under control.

Self-injectable cholesterol drug alirocumab is in the pipeline

Pharmaceutical giants Sanofi and Regeneron have developed a potentially ground-breaking new cholesterol drug – currently named ‘alirocumab’ – which analysts are predicting could be a massive sensation and bring in billions of dollars for its creators if the late-stage trials prove successful.

The new cholesterol-lowering drug is self-injectable and belongs to a class of biotech medicines named PCSK9 inhibitors, providing a different method of clearing the fatty deposits that can cause clogging within the arterial walls leading the way to a high risk of poor health, heart disease, strokes and other health complications.

Bad cholesterol, commonly referred to as “low density lipoprotein,” is one of the primary factors behind clogged arteries. If your body is generating sufficient amounts of good cholesterol, or “high density lipoprotein,” this helps the bad cholesterol to be cleared from the arterial walls and subsequently removed from the bloodstream via the liver. However, if you are low on good cholesterol, levels of bad cholesterol will rise and result in clogging in the arterial walls.

Health experts believe that PCSK9 inhibitors could be the biggest breakthrough in the fight against heart disease in two decades, since statins such as Lipitor, Crestor and Zocor have emerged.

Alirocumab contains man-made antibodies that target a particular protein which stops the body from getting rid of the bad LDL cholesterol from the bloodstream. They differ from the statins as statins actually prevent the liver’s production of LDL cholesterol.

Results from the new drug tested in a 100-patient trial are imminent and Sanofi are hopeful it may reach the market in two years’ time. Unfortunately, success will probably hinder on the results of more long-term clinical studies comprising on thousands of patients – and more reliable and trusted results will probably not be available for another five years from such studies.

Following tests in the initial Phase III study, alirocumab was found to reduce levels of LDL cholesterol by up to an incredible 72% and it is now being pitted against Merck’s Zetia, which has been shown to lower LDL cholesterol levels by around 19-24%.

Alirocumab is likely be prescribed to those with genetically-high cholesterol levels, patients deemed ‘high risk’ and who are not reaching cholesterol targets on whichever statin they are taking, and patients who could have a low tolerance to statins.

Speaking at a conference earlier this month, Sanofi’s CEO Chris Viehbacher said the French drugmaker may consider doubling its stake in Regeneron, clearing having faith in the ability and success of alirocumab.

He commented: “When you look at the number of patients who are willing to inject themselves daily for diabetes, and you know a lot of those patients are also going to be in your patient population for PCSK9, I actually think that the injectable part is not going to be as big a barrier as people think. I think it is going to be a paradigm shift for healthcare and a potentially huge opportunity for us.”

Unfortunately, the need for alirocumab to be injected and the high costs involved will deter many and pricing will be a major issue in the UK as the NHS already facing numerous deficit-cutting measures. Certainly the new drug, if and when it eventually hits the market, will be substantially more expensive than statins – currently prescribed to around 7 million people in the UK.

Cholesterol-lowering statins may help to slow the aging process

Statins are one of the most studied classifications of medications in the pharmaceutical industry as researchers gradually uncover the fantastic depths of their potential.

As well as their primary purpose of lowering low-density lipoprotein (LDL) cholesterol aka. ‘bad cholesterol’ and thus decreasing the risk of cardiovascular disease, statins such as Lipitor (Atorvastatin) and Crestor (Rosuvastatin) have even remarkably been linked with aiding the symptoms of erectile dysfunction, decreasing the risk of liver cancer, and are even being explored in the treatment of asthma.

However, the list of potential benefits of statins has one new addition, according to the findings of research published in September’s publication of The FASEB Journal.

A study conducted in Italy shows that statins may slow down the rate at which telomeres reduce in size – an important factor in our natural aging process. Therefore, this could pave the way for statins forming the basis of a revolutionary anti-ageing treatment.

“By telomerase activation, statins may represent a new molecular switch able to slow down senescent cells in our tissues and be able to lead healthy lifespan extension,” said Giuseppe Paolisso, M.D., Ph.D., a researcher involved in the work from the Department of Internal Medicine, Surgical, Neurological Metabolic Disease and Geriatric Medicine at Second University of Naples in Naples, Italy.

Paolisso and colleagues divided their study participants into two groups; one group on statin therapy and a second, control group, who were not taking statins. Following an analysis of telomerase activity for both groups, those taking statins were found to have a higher activity within their white blood cells and thus less telomeres shortening in comparison to the control group. This shows the importance of telomerase activation in slowing down the development of many short telomeres.

You’d be forgiven for not knowing what a ‘telomere’ actually is though. The ends of our chromosomes are comprised of cells containing a DNA sequence that helps to prevent the threads of DNA from unravelling; a fraying effect as a consequence of cell division. These ends are known as telomeres. Due to the fact they prevent chromosome ends from fraying and sticking to each other, telomeres are often compared to the plastic tips on shoelaces.

The importance of telomeres is because each time a cell divides, the telomeres get shorter. If they shorten too much, the cell becomes unable to divide and becomes inactive, ‘senescent’ or simply dies. This has been linked to aging, cancer and an increased risk of death.

Statins help to cut heart attack deaths by half

Firstly, Medical Specialists Pharmacy would like to wish everybody a slightly belated Merry Christmas and we hope everyone has had a fantastic few days with their family, friends and loved ones.

Secondly, we have already touched upon one group of people who may be vulnerable at Christmas time; asthmatics. However, those at risk of high cholesterol and heart problems need to be particularly cautious as well over the festive period.

Yesterday (Dec 26) is a day notorious for a high number of cardiac-related health problems such as heart attacks, heart failure and arrhythmias. A 2004 study conducted by researchers at the University of California, San Diego and Tufts University discovered that heart-related deaths go up by almost 5% during the Christmas holidays.

Some of the increased deaths can be attributed to a number of causes such as alcohol abuse as people already at risk of heart problems ignore the warnings and consume alcohol in excess, and some of the tragic fatalities are down to a build-up of Cholesterol – an important component of the blood stream that works at repairing body cells. However if excess cholesterol is not efficiently removed from the blood stream, it can pose a serious problem and cause deadly health issues such as stroke, heart attack and coronary heart disease.

As everybody is aware, stress levels for the majority of the UK and indeed around the world are at their peak over Christmas time as we frantically rush around for presents, planning time to see family and friends, and sorting last minute arrangements. Unfortunately stress and cholesterol are closely linked and when our stress levels increase, the production of two hormones – cortisol and adrenaline also increase.

Cortisol is known as the ‘stress hormone’ and it raises the sugars (glucose) in the bloodstream. Prolonged levels of cortisol have been shown to be connected to increased abdominal fat – linked to higher levels of ‘bad’ cholesterol (LDL) and lower levels of ‘good’ cholesterol (HDL), which can lead to all kinds of heart problems.

Cholesterol lowering medicines known as ‘Statins’ have been in the news throughout 2012 as health experts uncover more exciting findings about their capabilities. As stress and over indulgence of fatty foods increase our cholesterol over Christmas, it may come as good news to learn that British Heart Foundation statistics show that deaths from heart attacks have been cut by half, saving the lives of millions of people and this has been largely down to ‘wonder drug’ statins such as Crestor and Lipitor.

According to figures released by the British Heart Foundation, between the years 2002 and 2010 the death rate in men dropped from 78.7 deaths per 100,000 men to just 39.2 deaths per 100,000 men. Over the same 8 year block there was also a decrease in the death rate for females, 37.3 deaths per 100,000 women in 2002 fell to 17.7 deaths per 100,000 women in 2010.

The higher use of statin medication and blood thinning medication in conjunction with such lifestyle factors as fewer people now smoking have resulted in the decrease in heart attacks and other related problems. In addition, more advanced treatment than previous years means that those who do suffer from a heart attack, have a much better chance of surviving.

Professor Peter Weissburg, medical director of the foundation, said: “The last decade has seen excellent progress in heart attack prevention, treatment and care which has resulted in a dramatic reduction in the number of people dying from heart disease. Statins are an important part of that success story. They have undoubtedly changed the face of heart disease treatment for the better and there can be little doubt that there are thousands of people alive and well today because of statins. Whilst some people do experience irritating side effects, they are very rarely life threatening and the benefits far outweigh any risks. The progress we have witnessed over the last 10 years is something to celebrate but coronary heart disease is far from beaten and is still the single biggest killer in the UK. We must tackle the problem of inequalities which place an unfair burden of heart disease on our poorest communities. By dealing with the root causes of heart and circulatory disease – diet, smoking and lack of exercise – we should continue to see a decline in the numbers dying from a heart attack.”

Prescriptions for statins are now an incredible 15 times higher than 20 years ago, with estimates showing that approximately eight million people in the UK take statins every day. They work out to cost around just 40p per day and their benefits have led for calls for even more ‘healthy’ adults to be prescribed them too.

Thankfully, Medical Specialists Pharmacy provides private and confidential online consultations for statins, and for suitable patients our in-house doctors can prescribe statin medication such as Lipitor and Crestor, and our in-house pharmacists can dispense to patients within just 24 hours. We also dispense statins for patients who can provide a private prescription. If all that wasn’t enough, we also have the legally available generic Atorvastatin at much lower prices for suitable patients.

Statins may almost halve the risk of developing liver cancer

Cholesterol-busting statins such as Crestor (Rosuvastatin) and Lipitor (Atorvastatin) are currently prescribed to nearly a tenth (7 million) of the population in the United Kingdom, working their magic by raising good/protective cholesterol (HDL) and lowering bad cholesterol (LDL) and triglycerides. The higher your cholesterol level, the higher the chance of you suffering from a stroke or heart disease and thus increasing the overall risk of having a heart attack due to your arteries being clogged up with the fat-like substance known as cholesterol.

Health experts are continuously exploring the potential of statins though and already in the calendar year it has been found they could be beneficial for asthma sufferers, have been linked to a reduction in stroke occurrences and evidence suggest that even the healthier ones among us may reap rewards from taking them.

Amazingly, yet another study has emerged that shows their mind-boggling potential. This time, it is experts from the University of Milan who have decided to spend time to analyse the health boost that statins can bring-about, and they claim that a daily dose of cholesterol-busters can slash the risk of developing fatal liver cancer.

Researchers at the University collated information from a number of past studies that had focused on both statins and liver tumours. This kind of review of data is referred to as a ‘meta-analysis’ and is generally thought to be more accurate than other methods of analysis as it is collecting together results from a large number of studies in order to reach a more definitive conclusion on a particular medications effectiveness; in this case it is statins.

Their analysis looked at findings from five previous studies and uncovered that by taking statins on a regular basis, that person’s risk of developing a tumour was dramatically cut by an incredible 42% when compared against those who were not taking any form of statin medication.
This may now reinforce the argument of many health experts who have been calling for all people over the age of 50 to be prescribed statins to help stop a wide range of chronic and potentially fatal conditions, even if they are in the ‘low-risk’ category.

It is still not certain specifically how the statins work at offering a barrier against the formation of a liver tumour, and more work may need to be done in the future. In their report, published in the European Journal of Cancer Prevention, the Italian researchers commented: “Liver cancer is the third leading cause of cancer mortality and its rates have recently been increasing in central and northern Europe. This analysis suggests a favourable effect of statins on the disease.”

After seeing the report, Dr Safia Danovi, Cancer Research UK’s senior science information officer, gave his opinions and said: “This is interesting work but it doesn’t mean that cancer patients should start reaching for cholesterol-lowering drugs. Scientists, including our own, are asking whether statins could be used to treat cancer but we’re still a long way from a clear answer.”