Daily Dose

Are statins overprescribed for low-risk patients?

(Photos By Istock; Top Right By Mark Evans)
January 24, 2011

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It’s a common scenario: A 60-year-old woman is told she has high cholesterol but has no other risk factors for heart disease like high blood pressure, diabetes, or a smoking habit. Should she take a statin to lower her cholesterol?

Many doctors say, why not? But a review study by the Cochrane Collaboration, a nonprofit research organization, suggests otherwise. The review, which analyzed 14 trials involving the use of statins to prevent heart disease in low-risk patients, found only “limited evidence’’ that the drugs provide significant benefits, especially in women, and urged that “caution should be taken when prescribing statins’’ to prevent heart disease.

The cholesterol-lowering drugs — which include atorvastatin (Lipitor), rosuvastatin (Crestor), and simvastatin (Zocor) — have clearly been shown to reduce heart attacks, strokes, and deaths in higher risk patients such as those with diabetes or established heart disease. And they have minimal side effects.

In fact, the American Heart Association recommends that low-risk patients with high cholesterol consider taking a statin if lifestyle changes, such as increased exercise or weight loss, don’t work to bring cholesterol levels down.

But the Cochrane review study — written by British researchers — calls that practice into question, highlighting “shortcomings’’ in studies that found clear benefits in anyone who took statins to lower high cholesterol levels.

“The potential adverse effects of statins among people at low risk of [cardiovascular disease] CVD are poorly reported and unclear,’’ the authors wrote.

Other experts, though, disagree. “I think they make grand pronouncements that are wrong,’’ says Dr. Chris Cannon, a cardiologist at Brigham and Women’s Hospital who participated in another recent review study of statin use in low-risk patients published in the November issue of Lancet. (Cannon has accepted research grants from statin manufacturers and served on an advisory board for Bristol-Myers Squibb, which makes the statin Pravachol.)

The Lancet study found that high-risk and low-risk patients who take statins to lower their cholesterol can reduce their risk of having a heart attack, stroke, or heart procedure by 25 percent.

In absolute risk terms, statin users who don’t have heart disease would lower their yearly risk of having heart complications from 1.8 percent to 1.4 percent. Those who have already been diagnosed with heart disease would lower their yearly risk from 5.6 percent to 4.5 percent — and those with type 2 diabetes from about 5 percent to about 4 percent.

The lower your heart disease risk, the smaller the benefits you’ll receive from statins. That means the risk of side effects will play a greater role in determining whether you should take the drug. The Cochrane report found that statins didn’t increase the risk of cancer and posed a small risk of rhabdomyolysis, a serious condition involving the breakdown of muscles.

The biggest side effect, severe muscle soreness, occurs in about 3 to 5 percent of users, though some research indicates the incidence may be higher in women and for those who take higher doses or more potent statins. DEBORAH KOTZ

Why you should dim the lights at night

Ever wonder why you feel a little amped up after a nightime outing to a Red Sox game or the glaring lights of New York’s Times Square?

Exposure to bright lights at night appears to delay the release of the sleep-inducing hormone melatonin, according to a study of 116 healthy volunteers published this month in the Journal of Clinical Endocrinology & Metabolism. Volunteers who spent 24 hours straight in a room with constant light exposure at night reduced the time their bodies released melatonin by 90 minutes a day compared with when they were in rooms with very dim light during the evening and nighttime hours.

Did those bright lights inhibit their sleep? “We’re looking at the data on this now,’’ says study co-author Steven W. Lockley, a neuroscientist at Brigham and Women’s Hospital.

Lockley recommends the following: 1. Take electronic screens out of your bedroom; 2. Use dimmer lights closer to bedtime; 3. Avoid the bathroom light in the middle of the night. D.K.

Antioxidants could help infertile men

A new review of studies indicates that taking antioxidants could improve infertility problems in men. That “could,’’ though, should be underlined since the study review, published by the Cochrane Collaboration, only included 96 pregnancies and 20 live births in nearly 2,900 couples that were using assisted reproductive technologies.

Still, it seems to make sense for infertile men to take an antioxidant supplement. Over-the-counter supplements increased a man’s odds of ultimately achieving a health baby by nearly 500 percent. Of course, those incredible-sounding results don’t sound so spectacular when you consider how abysmally low the birth rates were among the infertile couples who were studied. Only about 9 percent of the men who took an antioxidant supplement achieved a baby with their partner compared to about 2 percent of men who took a placebo. D.K.

Seizures and flu shots in kids under 2

The flu vaccine Fluzone may be responsible for a higher than expected rate of febrile seizures in children ages 6 to 23 months who were vaccinated over the past few months, the FDA and the Centers for Disease Control and Prevention announced on Thursday. Some 36 reports of seizures among kids in this age group have been reported, according to the Associated Press.

All children recovered with no evidence of lasting harm. The government is investigating whether the vaccine caused the seizures.

Parents should realize that febrile seizures associated with vaccines are still very rare. And while these seizures look terrifying, “nearly all children who have a febrile seizure recover quickly and have no long-term effects,’’ according to the FDA’s website. D.K.