Statins Reduce Risks, Even in the Lowest Risk Groups

Current guidelines for the use of statins in the USA (Lipitor, Zocor, Crestor, Atoravastatin, Simvastatin, Pravastatin, etc.) call for only treating individuals who have a ten-year risk of major vascular event of at least 20%.

European researchers including Borislava Mihaylova, MSc DPhil, and colleagues on the Cholesterol Treatment and Trialists Collaborators team writing in the Lancet question whether the guidelines should be changed to treat individuals with even lower risks. Their large Meta analysis suggests that statins provide substantial benefits for primary prevention – especially in patients with a 5-10% ten year risk of a major vascular event. They looked at data from 27 trials including over 175,000 participants. When they took into account cost and side effects of statins, such as muscle pain and inflammation, rhabdomyolysis, diabetes and hemorrhagic stroke, they concluded that the benefits still far outweighed the risks. They think that the clear-cut affect on lower risk individuals coupled with the fact that almost 50% of vascular events occur in patients without previous cardiovascular disease necessitates the broadening of USA guidelines for treatment of patients. The researchers go on to hypothesize that as more generic statins enter the market, cost concerns will become far less of a factor in the decision to treat or not treat.

They noted that for each 1 mmol/L reduction in LDL cholesterol, there was a 21% reduction in the relative risk of major vascular events, and all cause death, irrespective of age, baseline LDL or previous cardiovascular disease.

This research makes it clear that there is great value in assessing the statistical cardiovascular risk of each individual and being more aggressive in the use of statins than current national guidelines call for.  Incorporating risk tools such as the Framingham Risk assessment plus looking at newer techniques such as the measurement of carotid artery intimal thickness may be appropriate in the decision to choose a statin or not.

Drinking Coffee, Lower Mortality

Over the years, the consumption of coffee and its relationship to your health has been controversial.  In my medical school, internship, and training years in the late 1970‘s, it was thought that consuming more than five caffeinated beverages per day was associated with an increased risk of pancreatic cancer. That relationship has since been disproved.

The May 17th issue of the New England Journal of Medicine published a study on coffee drinking that will certainly make coffee drinkers more comfortable with a consuming a “cup of Joe.” They looked at a National Institute of Health – AARP study that began 1995 and includes almost 230,000 men and 173,000 women. They found that coffee drinking was associated with many negative behaviors including cigarette smoking, less exercise, eating more red meat, and eating less fresh fruits and vegetables.  Upon initially looking at the data, coffee drinking was associated with an increased mortality. However, when researches removed the negative behaviors from the data, and looked at the people who drank coffee but didn’t smoke and exercised; they found a significant drop in the mortality of coffee drinkers. Over 13 years, men who drank 4-5 cups of coffee per day had a risk reduction of 12% while women had a risk reduction of 16%.

The risk reduction was considered “modest” by Neal Freedman, PhD of the National Cancer Institute.  Lona Sandon, RD (registered dietitian) of the UT Southwestern Medical Center in Dallas said, “Based on this study alone I would not tell people to start drinking more coffee to lower their risk of death.”   She felt individuals should “stop smoking, be more physically active, and eat fruits, veggies, whole grains and healthy fats…. A little coffee doesn’t appear to hurt.”  Cheryl Williams, RD, of Emory Heart and Vascular Center in Atlanta commented that “if you are not a coffee drinker, this study is not a good enough reason to start.”

The study seemed to show that with consumption of 4-5 cups of coffee per day your risk of death due to cardiovascular disease, respiratory disease, injuries and accidents, diabetes and infections decreased. Coffee consumption did not appear to protect against cancer-related deaths. The design of the study does not allow us the luxury of saying drinking coffee is the “cause” of an “effect” of lowered overall mortality, but does certainly hint at it.

What is clear is that coffee drinking does not appear to have an adverse effect on already healthy lifestyles, but will not protect an individual from the detrimental effects of smoking, poor dietary choices and inactivity.