Thursday, July 26, 2007

Extra Cardiac Effects of Statins

Statins (some call it "vastatin") has certainly revolutionised that prevention of coronary artery disease, or perhaps more correctly, atherosclerotic vascular disease. Statins obviously lower LDL-cholesterol, perhaps also increase HDL-cholesterol and also has obvious pleiotrophic, extra-cholesterol lowering effects (which remain difficult to prove, apart from statistical analysis and correlations). The different statins obviously have different efficacy from the results of clinical trials, some are more potent (the superstatins of atorvastatin and rosuvastatin) and the moderately powerful simvastatin and pravastatin.

The July 19th issue of the medscape medical news reported a study by Dr Wolozin, or all statin prescription from about 800,000 patients (730,000 taking simvastatin, 54,000 taking atorvastatins and 54,000 taking lovastatin), in US VA hospitals. The patients were followed from 2003-2005, and who were taking statins for cardiac indications and who also suffered from dementia or Parkinsonism. They were monitored by their neurologist and were re-evaluated after an average followup of at least seven months. They showed that the patients with dementia or Parkinsons showed a 50% improvement when they were taking simvastatin. Those who were taking atorvastatin showed a non-significant improvement. and those taking lovastatin did not show any improvement. The differential effects may be related to their lipophilicity. There were insufficient patients on fluvastatin or pravastatin. If this study were to be taken, then those cardiac patients who also has dementia or Parkinsons, should receive simvastatin.

However I think that we should need a bigger prospective randomised trial before we can make that recommendation. We also notice that simvastatin was the most often prescribed statin in US VA hospitals, although atorvastatin is the most popular statin in USA. We note the CNS effects, but what is the reason? Is it also related to LDL-cholesterol lowering, or is this a part of the anti-inflammatory statin effects. I am not even sure that dementia and Parkinsonism, are inflammatory conditions. Certainly, more studies need to be done. For the moment, if my patients have CAD and also Parkinsonism or dementia, I will seriously consider using a lipophlic statin (like simvastatin or atorvastatin), and obviously, I will ask them to avoid grape fruits.

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