Statins could shield an unborn baby from the mother’s stress

Cholesterol-boosting statins could be used to help protect unborn babies from being impacted by their mother’s stress and thus reducing the risk of that baby growing up with health problems later in their life.

Statins are the most commonly prescribed treatment in the United Kingdom, taken by approximately anywhere between 5 and 10 million people, and estimated to cost the NHS around £500 million a year. They are usually prescribed to lower the patient’s high cholesterol levels, but scientists now believe they may also help protect the hearts of babies in the womb.

Research conducted at Edinburgh University discovered that statins helped counteract the negative effects brought on by stress hormones on foetal growth and heart development in mice.
Those involved in the research into the drugs, claim that the therapy may decrease the chances of babies being born underweight, and lower their risk of suffering with health problems in later life, such as heart disease.

Although the findings emanated from a study of mice, this may now prompt further analysis into looking at the long-term effects of statins during a woman’s pregnancy. However, researchers say the drugs are currently already sometimes given to pregnant women and therefore should be OK for clinical trials.

Professor Megan Holmes, from the University of Edinburgh, said: “These are very exciting results suggesting that there may finally be a potential therapy for women whose placenta is unable to maintain the normal growth of her baby.

“At present there is no treatment and babies may be born prematurely or small, and will be at greater risk of developing cardiovascular disease, diabetes and even psychiatric disorders later in life.
“Although more work needs to be done to show statins are safe in human pregnancy, these results show a new way forward for the major unmet need of foetal growth retardation.”

Previous studies have shown babies are typically born under what is considered a ‘normal’ weight, following exposure to high levels of stress hormones within the womb, and have a much higher risk of heart disease as they get older.

Usually, an unborn baby gets protection from a key enzyme generated the placenta. The enzyme helps to destroy the stress hormones, reducing the quantity of active hormones that can get to the baby’s blood supply.

If the mother is experiencing high levels of stress, the placenta then produces less of the enzyme and the baby’s protection is reduced.

Therefore, the researchers involved in the latest study decided to analyse mice that are unable to produce the enzyme as a model of maternal stress. It was discovered that stress hormones prevent the placenta from developing regular blood vessels, hindering the blood supply to the foetus.

This stops the growing foetus from reaching a full size as a result, negatively impacting the heart function too.

However, researchers found that by treating the mother with the statin Pravastatin, actually managed to trigger the production of a molecule called VEGF. This worked at stimulating the development of blood vessels in the placenta. Pravastatin is just one of numerous statins provided by Medical Specialists® Pharmacy, which also includes atorvastatin and rosuvastatin.

The study – published in the journal Proceedings of the National Academy of Sciences and was funded by the Wellcome Trust – found that by re-establishing the blood supply, the treatment helped to promote a regular development of the heart. In addition, the baby was able to grow to a healthy birthweight.

Professor Jeremy Pearson, associate medical director at the British Heart Foundation, said: “Low birthweight has been associated with maternal stress, and babies with low birthweights may be more prone to cardiovascular complications later in life.

“In this study the researchers have discovered that a drug called Pravastatin may counteract the consequences of increased levels of the stress hormone corticosterone within the placentas of mice.
“How Pravastatin counteracts the stress hormone is not yet understood, therefore more research is needed to see whether the drug will have the same effect in humans.”

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.

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.

Earl Grey tea as good as statins at fighting heart disease?

Every office has that one person who is brew-shy and will avoid having to fill up the kettle at all costs! However, these type of people may reconsider after scientists discovered that drinking Earl Grey tea could help to protest against the onset of heart disease.

The tasty beverage – a popular drink in television program Downton Abbey -  contains a fragrant Mediterranean citrus fruit bergamot, an extract responsible for the distinct taste and smell which experts found can be as beneficial as statins like Atorvastatin or Pravastatin in lowering bad cholesterol and ultimately lowering the risk of heart disease.

New research has shown that Earl’s Grey tea contains enzymes called HMGF (hydroxy methyl glutaryl flavonones), which work at fighting the body’s proteins that help to cause cardiovascular disease – something which is the primary reason for a quarter of deaths in the UK.

The study was conducted by scientists from Italy’s University of Calabria, who worked with concentrations of HMGF on the proteins that are responsible for ‘bad’ cholesterol and heart disease.
Writing in the Journal of Functional Foods, they said that a dietary supplement of HMGF could be as comparable as statin therapy in fighting low-density proteins (LDL) or ‘bad’ cholesterol, with the bergamot extract with HMGF working just as well as the medications after comparison.

Not only were levels of the bad LDL cholesterol reduced, but researchers also found that the bergamot extract also increased HDL, also referred to as ‘good cholesterol’.

Citrus foods belong to the heavily praised ‘Mediterranean diet’, something which adhered to,  many health experts argue it can dramatically lower the risk of heart disease. Food and drink from this diet that can aid health include a moderate consumption of ethanol – derived from the wine, low consumption of meat, and high intake of vegetables, fruit, nuts, legumes, fish and olive oil.

Bergamot has only been added to many traditional Mediterranean‘folk’ medicines for the treatment of wounds, inflammation and as an antiseptic, in addition to its boost for the heart.

The journal’s report said: “High cholesterol is a common health concern for us all and often statins are given to help treat the condition. Extract from bergamot – most commonly used in Earl Grey tea – reduced total cholesterol and LDL levels but there was an increase in HDL levels (good cholesterol). Therefore a daily supplement of bergamot fruit extract could be very effective for the treatment of high cholesterol.”

Cholesterol-busting statins such as Crestor (Rosuvastatin) and Lipitor (Atorvastatin) are currently prescribed to around 7 million Brits and function by raising good/protective cholesterol (HDL) and lowering bad cholesterol (LDL) and triglycerides. The higher your cholesterol level, the higher your risk of suffering a heart attack or stroke due to your arteries being clogged up with the fat-like substance known as cholesterol.

Millions more to be prescribed statins to lower cholesterol

New NHS draft guidelines could mean millions more Brits are prescribed cholesterol-lowering statins to stave off heart attacks and strokes.

Current recommendations – implemented back in 2005 – mean that anybody with a 20% or greater chance of developing cardiovascular disease in the following decade are offered statins such as atorvastatin or pravastatin. The risk is calculated using factors such as age, weight, whether the person smokes and if there is a family history of the disease.

However, The National Institute for Health and Care Excellence (NICE) say the treatment should be broadened to include more people in order to save thousands more lives.  Cardiovascular disease remains the leading cause of death in the UK, claiming around 180,000 lives annually.

NICE now says that anyone with a risk at one in 10 or 10% should be offered statin medication, resulting in an estimated five million more Brits now taking the drugs, saving 2,000 lives and preventing 10,000 heart attacks or strokes every year.

This is according to Professor Colin Baigent, from the Oxford University team who conducted research published in The Lancet into the potential benefits of statins to more patients, finding the benefits of statins far exceed any side effects.

The new guidelines state doctors will be required to “make a judgment” about their patients with less than a 10% risk of developing cardiovascular disease and advise them accordingly.

NiCE says the draft guidance will make clear doctors need to work with at-risk patients to encourage them to improve lifestyle factors first that could put at risk, such as drinking less, stopping smoking and adhering to a healthy diet.

After these issues have been tended to, the patients should then be offered high intensity statin therapy.

Presently, around seven million people in the UK are currently statins; incredibly this is over a tenth of the UK’s population.

Professor Mark Baker, director of the centre for clinical practice at NICE, said: “People should be encouraged to address any lifestyle factors such as smoking, drinking too much or eating unhealthily. We also recommend that statins are now offered to many more people – the effectiveness of these medicines is now well proven and their cost has fallen.”

Professor Peter Weissberg, medical director at the British Heart Foundation, said: “Reducing your cholesterol level, whether that’s through medication or lifestyle changes, will reduce your risk of cardiovascular disease. The current guidance weighed the benefits of taking a statin against what was then the considerable cost to the health service. This pragmatic decision made sure that those of highest risk benefited. However, as most people who have a heart attack or stroke have average cholesterol levels and since statins are now much cheaper it makes sense to reconsider the threshold.”

Unfortunately, actually getting people to take their statins appears to be another issue. A 2012 study conducted by the British Heart Foundation discovered that an alarming 36% were not taking them.

Top tips for a healthy heart during National Heart Month

February is the time of year when we get to show our other half how much they mean to us, using all the love in our heart to go all out to impress and show we care.

However, in case you weren’t already aware, February is National Heart Month. It is a month-long campaign pioneered by the British Heart Foundation as a way to increase awareness about heart and circulatory diseases.

Although deaths from the two are falling, heart and circulatory disease is still one of the biggest killers in the UK and there are an estimated 2.6 million people living with Coronary Heart Disease (CHD) in the UK alone. We all have a heart, so we are all potentially at risk.

You can adhere to some basic lifestyle improvements though to improve your heart health and limit the risk of developing heart disease.

. Stop smoking

Smoking damages the lining of your arteries, meaning space for blood to pass through is decreased, and the carbon monoxide in cigarettes hinders the amount of oxygen that can travel to your heart and other areas of the body. Smokers are double the risk of suffering from a heart attack than non-smokers and smoking is the main cause of a multitude of cancers and lung disease.
. Stay active

Keeping fit and active is great for your waistline and general appearance, but exercise is great for the heart too. Unfortunately, statistics show that 7 out of 10 of us are not engaging in physical activity and thus are increasing their risk of heart disease. This doesn’t mean you need to rush to the local gym to sign up, but small changes can make a big difference. Keeping active helps to lower blood pressure; a risk factor for heart disease, boosts good HDL cholesterol responsible for moving fat away from arteries and back to the liver for processing and will help to improve circulation by stopping blood clots from forming which can cause a heart attack or stroke. A brisk walk for 30 to 40 minutes done three times per week should suffice to reduce your cardiovascular risk.

. Limit alcohol intake

Drinking more than the recommended units of alcohol per day (3-4 for men, 2-3 for women) can have a detrimental impact to your heart health. Excessive alcohol can raise the quantity of a type of fat in the blood called triglycerides and also lead to abnormal heart rhythms, high blood pressure, heart failure, stroke and obesity/diabetes from the additional calories you are taking in.

. Reduce your salt intake

If you, like so many others, have a diet that is high in sodium, this can lead to serious health problems. Sodium increases blood pressure as it causes the body to keep hold of excess fluid and blood volume increases, creating an added burden on the heart with increased pressure in the arteries. It is generally recommended that an adult should not consume more than 6g/1 teaspoon of salt each day. Certain foods are high in hidden salts and you should try to limit how much of them you eat. These include: baked beans, canned vegetables, cheese, crisps, pizzas and ready meals.

. Consider statins

Statins such as atorvastatin and pravastatin are tremendous for heart health because they target the metabolism of cholesterol in the body. Working in the liver, statins lower the bad LDL cholesterol in the bloodstream by between 20 and 60 per cent. High levels of bad cholesterol can cause fatty deposits to clog up your arteries and increase your risk of cardiovascular disease. Statins have been shown to lower the death rate from cardiovascular diseases without increasing the death rate from other causes. You may be prescribed statins even if you appear to be in good health, for example if you have a prominent family history of cardiovascular disease.

New guidance recommends millions more to take statins

There could soon be millions more British patients being prescribed cholesterol-lowering statins such as atorvastatin or pravastatin to safeguard against heart attack and stroke, following the publication of new guidelines in the United States of who would benefit from taking statins; the first such guidance to be released in the US in a decade.

The updated guidelines are based upon the findings of a new study conducted over four years by the American Heart Association and American College of Cardiology, who decided to ‘think outside the box’ so to speak, as to what constitutes putting someone at a risk of heart attack and/ or stroke.

The researchers, unlike many of their peers who conduct similar studies, shifted their interests away from high cholesterol and instead utilised a formula to calculate risk and looked at a person’s age, gender, race, together with certain health factors like smoking.

“This guideline represents a departure from previous guidelines because it doesn’t focus on specific target levels of LDL, or bad cholesterol, although the definition of optimal LDL cholesterol has not changed,” Dr Neil Stone, author of the report, said in a statement.

Dr Stone added: “The likely impact of the recommendations is that more people who would benefit from statins are going to be on them.”

Dr Donald Lloyd-Jones, one of the experts who help to draft the new guidelines, said: “We’ve been undertreating people who need statin therapy. Statins lower cholesterol levels, but what they really target is overall cardiovascular risk.”

More African-Americans – a demographic usually at a higher risk of stroke – could be prescribed statins in accordance to the new guidelines.

Under the guidance, there would now be approximately 44% of men and 22% of women who would be deemed suitable for taking statins – or 33 million Americans.

This is in stark contrast to previous US guidelines that meant only 15% of adults in America were recommended for statin treatment, whereby patients had to have a target set to lower their cholesterol to. These numerical targets have now seemingly been abandoned.

In creating the guidelines, the panel analysed four particular groups who they believed to need statins more than most: patients currently with heart disease, people with LDL levels of 190 or higher due to genetic risk, adults aged between 40 and 75 with type 2 diabetes and older adults with a 10-year risk of heart disease in excess of 7.5%.

Those in the panel also stressed the importance of a “diet pattern” which includes fruit, vegetables and whole grains, with all adults engaging in moderate to vigorous exercise three to four times per week.

Many of the patents on statins have expired, with significantly cheaper generic statins now available. Crestor (rosuvastatin), a statin manufactured by AstraZeneca, still remains under patent however and in 2012 alone the drug had impressive sales of $8.3bn (£5.2bn).

Statins are actually the most commonly prescribed drugs in the UK, used by almost a tenth of the population. As cholesterol is still the primary factor in the process of prescribing statins, it is worth noting that NHS guidelines state that LDL cholesterol should not be higher than 3.0 and overall cholesterol no higher than 5.0.