October 16, 2013
Statins May Have Beneficial Effects Beyond Cardiovascular Risk Reduction

Boston—New studies are showing beneficial effects for statin use beyond reducing cardiovascular risk.

Research from Harvard Medical School and Massachusetts General Hospital indicates that high-dose atorvastatin can reduce periodontal inflammation in as little as 4 weeks. A study from Johns Hopkins, meanwhile, suggests that statins not only fail to cause short-term memory issues but can actually reduce the risk of dementia over the long term.

The first study, published recently in the Journal of the American College of Cardiology, finds that statins may reduce nonarterial inflammation in tissues such as the periodontium. The authors note that less local tissue inflammation could lead to a reduction in proinflammatory mediators released into systemic circulation, which in turn may reduce atherosclerotic inflammation.

For the study, researchers compared the effect of a daily atorvastatin 80-mg dose versus a 10-mg dose in a randomized, multicenter trial with 71 subjects with established atherosclerosis or risk factors for atherosclerosis. Patients were evaluated using F-Flurodexoyglucose positron emission tomography (FDG-PET) imaging.

After 12 weeks, researchers identified a significant reduction in periodontal inflammation in subjects randomized to the 80-mg dose (P = 0.04). Participants with higher levels of periodontal inflammation at baseline (P = 0.01) and those with higher periodontal bone loss at baseline (P = 0.03) had the greatest reductions in periodontal inflammation. In addition, according to the results, reductions in periodontal inflammation correlated with reductions in carotid inflammation (P < 0.001).

“The impact of high-dose statin was greatest in individuals with evidence of active periodontitis and was evident after a four-week treatment period,” said lead author Sharath Subramanian, MD. “We observed a close relationship between reductions in periodontal and atherosclerotic inflammation. These results identify a potentially novel pleiotropic effect of statins and raise the possibility that an indirect benefit of statins on atherosclerosis may in part relate to a reduction in extra-arterial inflammation.”

For the second study, researchers reviewed dozens of studies on the use of statin medications to prevent heart attacks and found that the therapy does not affect short-term memory but may reduce the risk of dementia by 29% when used for more than a year.

Background in the article, published online by the Mayo Clinic Proceedings, notes that the questions about whether statins cause problems with cognition gained new urgency after 2012 drug label changes ordered by the FDA warned about memory problems with short-term statin use.

“All medications, including statins, may cause side effects, and many patients take multiple medicines that could theoretically interact with each other and cause cognitive problems,” said co-author Kristopher Swiger, MD. “However, our systematic review and meta-analysis of existing data found no connection between short-term statin use and memory loss or other types of cognitive dysfunction. In fact, longer-term statin use was associated with protection from dementia.”

The study included two different analyses involving a total of 41 different studies, which were narrowed to 16 with the most relevance. The first analysis looked at the impact of short-term statin use and cognitive function including memory, attention and problem-solving, based on studies including results from the Digit Symbol Substitution Test. The other analysis focused on studies measuring rates of Alzheimer’s disease or vascular dementia in patients taking statins for more than a year.

“Our goal was to provide clarity on this issue based on the best available evidence,” according to co-author Raoul Manalac, MD. “We looked at high-quality, randomized controlled trials and prospective studies that included more than 23,000 men and women with no prior history of cognitive problems. The participants in those studies were followed for up to 25 years.”

These types of studies are causing statins to be viewed in new ways, according to some commentators.

In an editorial related to the periodontal inflammation report, Michael Blaha, MD, MPH, of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, wrote, “Historically statins have been viewed as exclusively lipid-lowering medications that should be directed to patients with high serum lipid levels. A more modern perspective paints statins as cardiovascular risk-reducing medications with multiple possible mechanisms of action.”

The current study, he adds, “has tremendous potential implications for our philosophy toward statin allocation in primary prevention and future testing of new anti-atherosclerotic drugs.”

U.S. Pharmacist Social Connect