Health Briefs

June 28, 2002

Statins Reduce Cardiac Events Following Angioplasty
There is more good news regarding the beneficial effects of the statin-class drugs on cardiac health.   Currently, about 40% of patients undergoing angioplasty of their narrowed coronary arteries will experience recurrent symptoms or heart attack within 5 years of the procedure.  At 10 years post-angioplasty, more than two-thirds of patients will experience some adverse cardiac event.  A study reported in this week’s Journal of the American Medical Center (JAMA) evaluated 1,677 patients with severe coronary artery disease.  All patients had previously undergone balloon angioplasty of their narrowed coronary arteries, and had subsequently developed symptoms of recurrent arterial narrowing. 

In this study, 844 patients were treated with fluvastatin for 3-4 years, while the remaining 833 “control patients” received only a placebo.  The patients were then observed for progression of their symptoms of coronary artery narrowing, including worsening chest pain (angina), heart attack and cardiac death.  Overall, the patients taking fluvastatin experienced a 22% reduction in the incidence of these adverse cardiac events.  Patients with diabetes experienced a 47% reduction in cardiac events while taking fluvastatin, while patients with multiple diseased coronary arteries experienced a 34% reduction in cardiac events while taking fluvastatin.  Of particular importance, all patients participating in this study had normal cholesterol levels upon entering the study, despite their history of coronary artery disease.  The significant potential beneficial effects of statins on coronary artery health are, once again, confirmed by this important study.

Antioxidants & the Risk of Alzheimer’s Disease
Certain antioxidant compounds have been shown to reduce the risk of coronary artery disease and, possibly, some cancers.  Two new studies, also in JAMA, now suggest that moderately high doses of some antioxidant vitamins may reduce the risk of developing Alzheimer’s disease (AD).  In the first study, over 5,300 participants were enrolled between 1990 and 1993 in the Netherlands.  These study volunteers were then observed over the following 6 to 9 years for signs of AD.  Detailed dietary histories were compiled on every study volunteer.  The researchers found that moderately high daily doses of either vitamin E or vitamin C appeared to reduce the incidence of AD by 18%.  The beneficial effects of antioxidant vitamins was even more pronounced in smokers, who experienced a 35% reduction in the risk of developing AD with Vitamin C, a 42% risk reduction with vitamin E, and a 51% AD risk reduction with beta carotene (a vitamin A precursor).

The second study looked at the effects of these same antioxidant vitamins in the diets of 815 people aged 65 years and older.  This study found that people who consumed the highest levels of vitamin E in their diets experienced a whopping 70% reduction in the incidence of AD, while vitamin C and beta carotene did not appear to reduce the risk of developing AD.  It should be noted that these results were based upon diet questionnaire results, which rely upon a participant’s recollection of their dietary habits.  Taken together, however, these two studies appear to support at least the use of vitamin E as a preventive agent for AD.  These results also implicate free radicals as possible contributors to changes in the brain that can result in AD.

Effects of Exercise on the Hearts of Patients with Mild Hypertension
Even mild cases of longstanding high blood pressure can cause thickening of the walls of the left ventricle, the heart’s primary blooding pumping chamber.  This process, termed left ventricular hypertrophy (LVH), increases the risk of further heart damage and death.  It is known that exercise alone can reduce the severity of high blood pressure in most patients.  However, the effects of exercise on LVH, if any, are unknown.  Eighty-two sedentary volunteers with mild-to-moderate high blood pressure were enrolled in the study, and were placed on a moderate exercise and dieting regimen.  The study, reported in the Archives of Internal Medicine, found that moderate exercise and dieting not only reduced elevated blood pressure, but also significantly reduced LVH as well.  This is good news for millions of sedentary men and women with mild or moderate high blood pressure, and adds to the extensive data supporting the many beneficial effects of exercise and weight control.

Briefly…
Archives of Internal Medicine: elevated blood levels of homocysteine have been linked to an increased risk of coronary heart disease.  A Norwegian study has studied the incidence of significant heart disease in 17,361 individuals, and found that patients with the highest levels of homocysteine in their blood had a nearly two-fold risk of developing heart disease when compared to people with the lowest homocysteine levels.  It is worth noting that the vitamin folate can reduce homocysteine levels in the blood.

Archives of Internal Medicine: Nut consumption has previously been linked to a reduced risk of death from coronary heart disease.  Some studies have suggested that certain fatty acids in nuts may stabilize the heart’s rhythm in patients with underlying coronary artery disease.  This study evaluated 21,454 male physicians over an average of 17 years.  The men who consumed nuts at least two times per week experienced about half the risk of sudden cardiac death as the men who rarely or never consumed nuts, as well as a 30% reduction in the risk of coronary artery-related death.  As with other studies based upon dietary surveys, it is difficult to exclude other factors that might have contributed to these results.  However, the large number of participants in this study increases the likelihood that this apparent heart-protective effect of nuts is, indeed, real.

Archives of Internal Medicine:  The benefits if the statin drugs in elderly patients has not been well-studied.  A study of 1,250 women and 664 men aged 65 or older showed that the use of a statin drug reduced the risk of heart attack or cardiac death by an impressive 54% during the 8-year study period.

New England Journal of Medicine: Oral contraceptive pills (OCPs) have previously been suspected of increasing the risk of breast cancer after prolonged use, although the data to support this claim has not been very strong.  At the same time, there is more compelling data suggesting that OCPs actually reduce the risk of ovarian cancer.  A new study has evaluated OCP use in 4,575 women with breast cancer and 4,682 women without breast cancer.  Among women using OCPs, either presently or in the past, no increase in the incidence of breast cancer was identified when compared to age-matched women who had never taken OCPs.  This study offers reassuring evidence for the safety of OCPs, particularly in women who do not smoke.  On the other hand, hormone replacement therapy pills, which contain higher levels of estrogen than OCPs, have been linked to a small increase in the incidence of breast cancer.

Dr. Robert A. Wascher