by Mary Brophy Marcus, Healthday Reporter
When combined with other cholesterol-lowering treatments, they could be as good as high-dose statins alone.
(HealthDay)—A new analysis suggests that people at high risk for heart disease who can't take high-dose statin drugs to lower their cholesterol might benefit from a treatment combination that includes taking a low-dose statin.
Scientists at Johns Hopkins reviewed published research to compare the benefits and harms of a lower-intensity statin when combined with one of several other cholesterol-lowering treatments in adults at high risk for heart disease.
Study author Dr. Kimberly Gudzune said combining a low-dose statin with either a so-called bile acid sequestrant or Zetia (ezetimibe)—both of which are medications that also work to lower cholesterol levels—lowered "bad" (LDL) cholesterol. Taking a high-dose statin by itself also lowered LDL levels.
"At least in the short term, this strategy seems to be as effective as the high-dose statin alone, although there were two major caveats: We don't know much about side effects and we don't know about long-term effectiveness," said Gudzune, an assistant professor of medicine at Johns Hopkins.
She also said the researchers were not able to draw conclusions about mortality or heart problems such as heart attacks.
There was not enough evidence regarding LDL cholesterol reduction when it came to using a low-dose statin with fibrates, niacin or omega-3 fatty acids, Gudzune said. Fibrates can lower levels of blood fats known as triglycerides and can sometimes raise levels of "good" (HDL) cholesterol.
The review was published online Feb. 10 in the journal Annals of Internal Medicine.
The American College of Cardiology and the American Heart Association cholesterol guidelines recommend moderate- or high-intensity statin therapy for people whose medical conditions or cholesterol levels put them at risk for heart disease—the leading cause of death for both men and women in the United States.
But some patients don't respond to high doses of statins and some suffer from side effects, including muscle pain, Gudzune said.
"It doesn't happen infrequently that patients come in and say, 'I'm having muscle pains on this statin,'" she said. "So we wanted to review the literature and help shed a little bit of light on it for those patients."
Gudzune said they aren't yet sure of the long-term benefits of combining low-dose statins and other medications.
"Unfortunately, we weren't really able to examine the risk for [heart] events like heart attacks or strokes," she said. "We aren't sure if it translates into decreased [heart] risk."
Dr. Chip Lavie is medical director of cardiac rehabilitation and preventive cardiology at the John Ochsner Heart and Vascular Institute in New Orleans.
"This is a nice paper," Lavie said. "But I suspect that many clinicians ... already know that a lower-dose statin combined with a second lipid agent—most know this best with ezetimibe—produced at least similar but probably slightly better [results] ... compared with lower-dose statins alone."
Based on the most recent guidelines, Lavie said, doctors should try to get patients to tolerate the proven therapies before resorting to other less proven "but potentially very effective treatment approaches."
Explore further: Most statin-intolerant patients can eventually tolerate statins
More information: Visit the American Heart Association for more on cholesterol.
Copyright © 2014 HealthDay. All rights reserved.
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by Mary Brophy Marcus, Healthday Reporter
When combined with other cholesterol-lowering treatments, they could be as good as high-dose statins alone.
(HealthDay)—A new analysis suggests that people at high risk for heart disease who can't take high-dose statin drugs to lower their cholesterol might benefit from a treatment combination that includes taking a low-dose statin.
Scientists at Johns Hopkins reviewed published research to compare the benefits and harms of a lower-intensity statin when combined with one of several other cholesterol-lowering treatments in adults at high risk for heart disease.
Study author Dr. Kimberly Gudzune said combining a low-dose statin with either a so-called bile acid sequestrant or Zetia (ezetimibe)—both of which are medications that also work to lower cholesterol levels—lowered "bad" (LDL) cholesterol. Taking a high-dose statin by itself also lowered LDL levels.
"At least in the short term, this strategy seems to be as effective as the high-dose statin alone, although there were two major caveats: We don't know much about side effects and we don't know about long-term effectiveness," said Gudzune, an assistant professor of medicine at Johns Hopkins.
She also said the researchers were not able to draw conclusions about mortality or heart problems such as heart attacks.
There was not enough evidence regarding LDL cholesterol reduction when it came to using a low-dose statin with fibrates, niacin or omega-3 fatty acids, Gudzune said. Fibrates can lower levels of blood fats known as triglycerides and can sometimes raise levels of "good" (HDL) cholesterol.
The review was published online Feb. 10 in the journal Annals of Internal Medicine.
The American College of Cardiology and the American Heart Association cholesterol guidelines recommend moderate- or high-intensity statin therapy for people whose medical conditions or cholesterol levels put them at risk for heart disease—the leading cause of death for both men and women in the United States.
But some patients don't respond to high doses of statins and some suffer from side effects, including muscle pain, Gudzune said.
"It doesn't happen infrequently that patients come in and say, 'I'm having muscle pains on this statin,'" she said. "So we wanted to review the literature and help shed a little bit of light on it for those patients."
Gudzune said they aren't yet sure of the long-term benefits of combining low-dose statins and other medications.
"Unfortunately, we weren't really able to examine the risk for [heart] events like heart attacks or strokes," she said. "We aren't sure if it translates into decreased [heart] risk."
Dr. Chip Lavie is medical director of cardiac rehabilitation and preventive cardiology at the John Ochsner Heart and Vascular Institute in New Orleans.
"This is a nice paper," Lavie said. "But I suspect that many clinicians ... already know that a lower-dose statin combined with a second lipid agent—most know this best with ezetimibe—produced at least similar but probably slightly better [results] ... compared with lower-dose statins alone."
Based on the most recent guidelines, Lavie said, doctors should try to get patients to tolerate the proven therapies before resorting to other less proven "but potentially very effective treatment approaches."
Explore further: Most statin-intolerant patients can eventually tolerate statins
More information: Visit the American Heart Association for more on cholesterol.
Copyright © 2014 HealthDay. All rights reserved.
Medical Xpress on facebook
Related Stories
Most statin-intolerant patients can eventually tolerate statins
Sep 09, 2013
Most patients who report statin intolerance, including muscle aches and other side effects from the cholesterol-lowering drugs, can actually tolerate drugs from this class on subsequent trials, according to research from ...
Higher-dose use of certain statins often best for cholesterol issues
Oct 15, 2012
(Medical Xpress)—A comprehensive new review on how to treat high cholesterol and other blood lipid problems suggests that intensive treatment with high doses of statin drugs is usually the best approach.
ACC/AHA publish new guideline for management of blood cholesterol
Nov 12, 2013
The American College of Cardiology and the American Heart Association today released a new clinical practice guideline for the treatment of blood cholesterol in people at high risk for cardiovascular diseases caused by atherosclerosis, ...
Researchers find alternative cholesterol-lowering drug for patients who can't tolerate statins
Mar 11, 2013
Heart patients who can't tolerate the side effects of cholesterol-lowering drugs may have a new option, according to a new study by researchers from the Intermountain Heart Institute at Intermountain Medical Center in Salt ...
Integrative medicine: New guidelines recommend statins for 30 million Americans
Jan 31, 2014
Breaking news: One quarter of Americans reading this article should be on a cholesterol-lowering statin medicine per new guidelines put out last month by the American Heart Association and the American College of Cardiology.
Recommended for you
Surprising trends in cause of long-term death after percutaneous coronary intervention
3 hours ago
More people who have known coronary heart disease die from other causes—such as cancer, and lung and neurological diseases—than heart disease, compared with 20 years ago, according to a Mayo Clinic study published online ...
Heart attack research discovers new treatment target
4 hours ago
Research led by David Lefer, PhD, Professor and Director of the Cardiovascular Center of Excellence at LSU Health Sciences Center New Orleans School of Medicine, demonstrates for the first time cross-talk between two protective ...
Racial / ethnic differences in CHD outcomes not due to statins
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(HealthDay)—For hospitalized patients with coronary heart disease (CHD), racial and ethnic differences in one-year outcomes are due to demographics and comorbidity, not differential statin prescriptions, ...
Rapid recovery on exercise ECG may obviate need for more tests
Feb 07, 2014
(HealthDay)—Additional testing for ischemic heart disease is less likely to yield benefit in those with rapid recovery of electrocardiographic (ECG) changes on the exercise treadmill test (ETT), according ...
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Feb 07, 2014
New genetic evidence strengthens the case that one well-known type of cholesterol is a likely suspect in causing heart disease, but also casts further doubt on the causal role played by another type. The findings may guide ...
Beta blockers and perioperative care: EHJ addresses controversy
Feb 07, 2014
Since the end of 2011 when the scientific work of Professor Don Poldermans was first scrutinized there has been controversy in the medical world about the use of beta blockers in perioperative care.
User comments
© Medical Xpress 2011-2014, Science X network
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