Tips from gaining health

High doses of statins prevent dementia in older people, according to research presented at the ESC Congress today by Dr. Tin-Tse Lin from Taiwan. The study of nearly 58,000 patients found that high potency statins had the strongest protective effects against dementia.

The study examined whether statin use was associated with new diagnoses of dementia. The researchers used a random sample of 1 million patients covered by Taiwans National Health Insurance. From this they identified 57,669 patients aged >65 years who had no history of dementia in 1997 and 1998. The analysis included pre-senile and senile dementia but excluded vascular dementia.

There were 5,516 new diagnoses of dementia during approximately 4.5 years of follow-up. The remaining 52,153 patients aged >65 formed the control group. Subjects were divided into tertiles according to their mean daily equivalent1 dosage and total (across the entire follow up period) equivalent dosage.

The adjusted hazard ratios (HRs) for dementia were significantly inversely associated with increased daily or total equivalent statin dosage. The HRs for the three tertiles of mean equivalent daily dosage (lowest to highest) were 0.622, 0.697 and 0.419 vs control (p<0.001 for trend). The HRs for the three tertiles of total equivalent dosage (lowest to highest) were 0.773, 0.632 and 0.332 vs control (p<0.001 for trend). The protective effect of statins remained in different age, gender and cardiovascular risk subgroups.

Dr Lin said: "The adjusted risks for dementia were significantly inversely associated with increased total or daily equivalent statin dosage. Patients who received the highest total equivalent doses of statins had a 3-fold decrease in the risk of developing dementia. Similar results were found with the daily equivalent statin dosage."

He added: "It was the potency of the statins rather than their solubility (lipophilic or hydrophilic) which was a major determinant in reducing dementia. High potency statins such as atorvastatin and rosuvastatin showed a significant inverse association with developing dementia in a dose-response manner. Higher doses of high potency statins gave the strongest protective effects against dementia."

Dr Lin continued: "The results were consistent when analysing daily doses of different kinds of statins. Almost all the statins (except lovastatin) decreased the risk for new onset dementia when taken at higher daily doses. A high mean daily dosage of lovastatin was positively associated with the development of dementia, possibly because lovastatin is a lipophilic statin while the anti-inflammatory cholesterol lowering effect of lovastatin is not comparable to that of atorvastatin and simvastatin."

Dr Lin concluded: "To the best of our knowledge, this was the first large-scale, nation-wide study which examined the effect of different statins on new onset dementia (except vascular dementia) in an elderly population. We found that high doses of statins, particularly high potency statins, prevent dementia."

Researchers from The University of Texas MD Anderson Cancer Center found statins, the commonly used drug to lower cholesterol, improved progression-free survival in patients with inflammatory breast cancer (IBC).

The retrospective study was presented today in a poster discussion at the 2012 CTRC-AACR San Antonio Breast Cancer Symposium and follows a previously reported Danish study indicating there is some evidence to suggest the anti-inflammatory properties of statins could reduce the risk of breast cancer recurrence. Still, the overall effects of statins have not been examined in relation to IBC.

IBC is a rare type of breast cancer that develops quickly when malignant cells block lymph vessels in the skin and soft tissue. It accounts for only 1-5 percent of all invasive breast cancers, according to the American Cancer Society.

"We decided to take a different approach with the smaller population of inflammatory breast cancer patients and see if its truly an inflammatory disease, whether or not theres some substantial impact of statin use in this population," said Naoto T. Ueno, M.D., Ph.D., professor in MD Andersons Department of Breast Medical Oncology and executive director of the Morgan Welch Inflammatory Breast Cancer Research Program and Clinic.

Ueno, the corresponding author, and his colleagues reviewed 724 patients diagnosed and treated for stage III inflammatory breast cancer at MD Anderson between 1995 and 2011. Patients with records indicating statin use at the time of diagnosis were compared to those who were not taking statins. In total, the stage III group contained 74 statin users and 650 non-users.

The primary end-point was progression-free survival (PFS), while secondary end-points measured overall survival (OS) and disease-specific survival (DSS).

Additionally, researchers compared the clinical outcomes of those in the statin group based on the type of statin, lipophilic (fat-soluble) or hydrophilic (water-soluble), an important distinction as differences in survival emerged throughout the trial. The authors note patients who used both drug categories, or patients missing information on their specific statin type, were excluded from the survival estimates.

Outcomes Show Improvement

Patients with no record of statin use had 1.76 years DFS, while patients who took lipophilic statins saw improved survival rates of 2.47 years. The greatest improvement in survival was noted in patients with past hydrophilic statin use at 4.88 years.

Increased survival rates also extended to the DSS end-point. Patients with no statin use measured a DSS of 4.52 years, while hydrophilic patients measured 5.10 years.

The authors note there is a trend in overall survival, however the OS end-point did not reach statistical significance.

"The previous Danish study looking at statins examined a much larger group of participants, around 10,000 and more. So were talking about a much smaller set of inflammatory breast cancer patients and to see the significant improvement in survival gives us a new perspective on the use of statins," said Ueno.

While Ueno added the findings are encouraging, the study does have limitations. First, no data was available describing how long patients had been taking statins, or for what indication. Those who did use statins may represent a population with better access to health care, a more health-conscious lifestyle and a higher education level, according to the researchers.

"This is an existing drug that was not developed for cancer and while developing new agents is important, statins are currently in the market and may have a significant role in the treatment we provide," he said.