information in this column is intended for informational
purposes only, and does not constitute medical advice or
recommendations by the author. Please consult with your
before making any lifestyle or medication changes, or if you have any
other concerns regarding your health.
is difficult to write about the class of drugs known as statins without
affecting an almost religious fervor for them amid the growing list of
beneficial effects associated with the most commonly prescribed drugs
in the United States.
The statins were
originally developed for their ability to block an enzyme required by
the body for the synthesis of cholesterol.
Thus, the statins decrease total cholesterol levels in the blood and,
additionally, they also specifically reduce LDL (the “bad cholesterol”)
levels as well.
research studies have shown that statin drugs reduce the risk of heart
disease and heart attacks in patients with elevated cholesterol levels.
Additional research has also strongly suggested that statins can also
reduce the risk of cardiovascular disease even in patients with normal
additional research into the biochemical function of these powerful
drugs has also revealed other mechanisms of action in addition to their
known effects on cholesterol synthesis and metabolism.
One of the most clinically important additional mechanisms of action of
statins appears to be their ability to reduce inflammation throughout
the body. These
have been linked not only to the statins’ ability to reduce
cardiovascular disease, but also to potentially reduce the risk of
stroke and, perhaps, some cancers as well.
However, the data supporting these additional potential benefits of
statins is less well developed than that for cardiovascular disease
reduction. I should
also stress that not
all claims currently being made for statins are likely to turn out to
be true, and that, as with all medications, statins have been
associated with potentially serious side effects (most notably injury
to the liver and muscle tissue).
it is still difficult to think of any other recently developed class of
medications that have accumulated a more profound disease prevention
profile than the statins.
Two new research
studies have added to the already impressive and growing legacy of
statin drugs, and suggest an important role for these medications in
patients with diabetes, and in the prevention of strokes.
rising incidence of diabetes mellitus in the developed world parallels
the rising incidence of obesity, and not surprisingly.
Adult-onset, or Type II, diabetes has long been known to be linked with
overeating and obesity.
Although diabetes results from a complicated array of genetic and
metabolic abnormalities, Type II diabetes fundamentally involves a
combination of reduced insulin output from the pancreas and a decreased
sensitivity of the body’s cells to insulin.
The regulation of glucose (“sugar”) levels in the blood is the results
of complex feedback mechanisms between multiple tissues and organs in
the body. When
glucose levels rise in the blood after a meal, the pancreas is
stimulated to increase insulin production and secretion.
Insulin, in turn, causes glucose to leave the bloodstream and to enter
into the body’s cells, where it can then be utilized to meet the cells’
energy needs. In
Type II diabetes, not
enough insulin is available from the pancreas, and this overall insulin
deficiency is further aggravated by a reduction in the body’s
sensitivity and response to insulin.
abnormalities cause the level of glucose in the blood to rise above
normal and, over time, a host of diabetes-associated illnesses may
result if the disease is not aggressively treated and controlled.
Much of the adverse health effects of poorly controlled diabetes
revolve around the early onset and progression of atherosclerotic
vascular disease. In
patients with chronic
diabetes, the thickening and ulceration of the lining of critical blood
vessels that normally and gradually occurs with aging is accelerated. In particular, smaller
caliber blood vessels appear to be preferentially affected in patents
In many patients with poorly controlled diabetes, this can eventually
result in kidney failure, heart attacks, stroke, blindness, and
decreased circulation to the feet and toes.
Weight loss, decreasing sugar and carbohydrates in one’s diet,
exercise, and (when necessary) medications to control blood glucose
levels can all effectively treat most cases of Type II diabetes, and
can markedly reduce the risk of diabetes-associated illnesses.
attention has turned towards the statins and their potential impact on
the adverse effects of diabetes.
Because of the increased risk of accelerated atherosclerosis in
patients with diabetes, there has been great interest in the use of
statins to slow down, or even arrest, this pathological process. A new study in the journal The Lancet
combined the results from 14 randomized clinical research trials that
evaluated the impact of statins on patients with diabetes.
Using a statistical method known as meta-analysis, the data from these
14 studies were adjusted and combined in such a way that more powerful
scientific deductions could be made (please note, however, that
meta-analyses carry their own potential “scientific biases” in their
methodology, and are, therefore, far from perfect themselves).
study analyzed data from almost 19,000 patients with diabetes, and
compared them to more than 71,000 patients without diabetes.
After following all of these patients for an average of just over 4
years, 3,247 “major vascular events” were observed among the study
the use of statins was associated with a significant and approximately
equal reduction in the risk of death from vascular causes in both the
diabetic and non-diabetic patients, and the extent of this reduction in
the risk of death was directly proportional to the degree to which LDL
levels were reduced after beginning statin therapy.
Specifically, this large study appeared to confirm that diabetic
patients who received statin drugs had a significantly reduced
incidence of heart attack, death due to heart attack, intervention for
narrowed coronary arteries, and stroke.
Once again, the degree of risk reduction for each of these “adverse
vascular events” was directly proportional to the extent of LDL
reduction after starting statin therapy in both the diabetic and
non-diabetic study volunteers.
results of this study, when combined with previous research, strongly
support the use of statins in patients with diabetes who are at
increased risk of developing cardiovascular disease.
As a reminder, the use of statins may be associated with serious side
effects, and so patients who are placed on these medications must be
closely monitored by their prescribing physician.
second large meta-analysis study, just published in The
American Journal of Medicine,
evaluated the results of 42 clinical research trials looking at the
impact of statin therapy on the risk of death in general, and the risk
of stroke, specifically, among more than 121,000 study volunteers.
Among the volunteers taking statin drugs, death from any cause was
reduced, relatively, by 12%, and the relative risk of stroke was
reduced by 16%. As
with the previous study,
the extent of morality and stroke risk reduction was proportional to
the magnitude of LDL reduction achieved after initiation of statin
therapy. One caveat
derived from this study
is that the risk of only so-called “non-hemorrhagic” strokes was
reduced by chronic statin therapy.
type of stroke generally results from atherosclerosis of the arteries
(in the neck and inside the brain) that supply the brain with blood.
The incidence of “hemorrhagic” strokes, which usually result from
poorly controlled high blood pressure (or, in some cases, in patients
taking blood-thinning medications), was not reduced by statin therapy,
Additionally, the incidence of fatal strokes was not appreciably
altered by statin drugs.
with prior studies, this large meta-analysis adds to the growing weight
of evidence that long-term statin therapy can significantly reduce the
risk of life-threatening cardiovascular events.
GERD & ESOPHAGEAL CANCER
the incidence of cancers of the upper half of the esophagus has been
declining in the western world, the incidence of a type of cancer that
involves the lower esophagus and upper stomach has been on the rise.
A great deal of debate within the medical and scientific communities
has yet to clarify the reason(s) for the increasing incidence of
adenocarcinoma of the lower esophagus and gastro-esophageal (GE)
new research study from Australia, just published in the journal Gut, may offer some insight into
potential risk factors for this very serious cancer.
The authors evaluated almost 800 patients with adenocarcinoma of the
esophagus and GE junction, and compared them to 1,580 adults without
cancer. This study
searched for clinical
and lifestyle factors that were more commonly associated with the
presence of lower esophageal or GE junction adenocarcinoma and that,
therefore, might be considered as risk factors for this type of cancer.
the two populations of study volunteers were evaluated according to
body weight, obesity was identified as a factor that significantly
increased the risk of this particular type of cancer.
When comparing the heaviest study volunteers with those who had normal
height-adjusted body weights, the risk of lower esophageal
adenocarcinoma was increased more than 6-fold in the heaviest adults.
Obesity also appeared to worsen the risk of this cancer more
prominently in men than in women, and in those less than 50 years of
age when compared to patients older than 50.
When obesity was present in combination with ongoing symptoms of acid
reflux (gastro-esophageal reflux, or GERD), the risk of developing
adenocarcinoma of the lower esophagus was increased dramatically, to
nearly 17 times the risk apparent in non-obese adults without symptoms
of GERD. Any degree
of obesity, without
symptoms of GERD, was associated with a more than 2-fold increase in
the risk of this cancer, while symptoms of GERD without attendant
obesity was associated with a nearly 6-fold increase in risk.
Similar associations were observed with adenocarcinoma of the GE
junction, although the magnitude of increased cancer risk associated
with obesity and/or GERD was not as great as was observed for
adenocarcinoma of the esophagus.
results of this rather small public health study fit in nicely with the
results of previously published studies.
Chronic GERD has long been associated with an increased risk for
adenocarcinomas of the lower half of the esophagus, and the GE junction.
Chronic inflammation of the lining of the lower half of the esophagus
is thought, by many experts, to be the primary cause of this highly
lethal from of cancer.
Obesity, which is
itself a risk factor for GERD, has repeatedly been linked to cancers of
the esophagus and GE junction by previous studies as well.
(Other cancers previously linked to obesity include cancers of the
breast, colon, rectum, pancreas, ovary, uterus, prostate and kidney.)
The results of this study further suggest that the co-existing
combination of obesity and GERD may dramatically increase the risk of
esophageal and GE junction adenocarcinoma, and to a much greater degree
than the presence of either risk factor alone. The primary limitations
of this study are that it evaluated a relatively small population of
patients, and as with many epidemiological studies, this is a
comparative study that seeks to associate specific findings in one or
more groups of patients at a single point in time.
(Associating the presence or absence of a disease, at a single point in
time, with suspected risk factors for that same disease tends to
overestimate the magnitude of the risk factors being studied.)
you are overweight, then this study provides yet another source of
motivation to bring your weight down to within the recommended normal
range. Likewise, if
you have chronic or
frequent heartburn or regurgitation symptoms, or any other symptoms of
GERD, you should also seek evaluation and advice from your personal