Statins, the emerging indications

Main Category: Statins
Article Date: 17 Sep 2004 - 16:00 PDT


Mechanisms proven, theorized, and yet-to-be considered may be at work in the early, but promising findings on an entire spectrum of emerging statin indications. Although investigators caution against jumping to clinical conclusions, preliminary evidence argues strongly in favor of further investigation on multiple disease fronts.

The statin drugs - 3-hydroxyl-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors - have become the class of choice for management of hypercholesterolemia. Since the first FDA statin approval in 1987, all currently-approved drugs in the class have shown efficacy in lowering LDL cholesterol (LDL-C), total cholesterol, and triglycerides, while also raising HDL cholesterol (HDL-C). Acting in a dose-dependent manner, the effects on cholesterol can be dramatic. Depending on the specific drug and dose, LDL-C can be reduced well over 40% and triglycerides in excess of 30%.

Hyperlipidemia as a cardiac risk factor and the mechanism of statins continue to be investigated. In response to recent trial findings, the National Cholesterol Education Program (NCEP) issued a 2004 report noting that LDL-lowering appears to be beneficial in patients at risk of cardiovascular disease (CVD) regardless of their current LDL level. While the NCEP report reinforces the role of therapeutic lifestyle change as an essential part of overall lipid management, others note the multifactorial process associated with CVD progression and suggest the cardioprotective effects of statins may be a result of something more than lipid modulation. Statins appear to improve endothelial function via several possible pathways; there is growing recognition of statin anti-inflammatory, antioxidant, and angiogenic properties; and there is evidence to suggest at least some in this class may modulate immune responses.

There is now considerable epidem-iological evidence suggesting statins can reduce risk of Alzheimer's disease and possibly slow its progression. Results of at least one small U.S. study even offer hope for reversing the disease process. "Studies of increasing size have demonstrated that people who take statin drugs for current indications have less Alzheimer's," says William H. Thies, PhD. "These studies have been done in different parts of the US and have had varying patient characteristics. There has been one small randomized trial of statin use in people with Alzheimer's disease with promising results. This has provided enough encouragement that two large trials are now in progress. We should have results in the next two years." CONTINUES......www.physweekly.com

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