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Statin Might Help Fight Blood Clots in Veins

Cholesterol-lowering Crestor cut risk by 43%, study found

MONDAY, March 30 (HealthDay News) -- In addition to dramatically reducing the incidence of heart attacks and stroke, the cholesterol-lowering drug Crestor appears to have another important benefit: reducing the rate of blood clots in the veins, new research has found.

Interestingly, participants in this study, which was presented Sunday at the American College of Cardiology annual meeting, in Orlando, Fla., did not have elevated levels of LDL, or "bad," cholesterol, but they did have increased levels of the inflammatory marker called C-reactive protein (CRP).

"This suggests that a statin has potential beneficial effects on the venous circulation, not just the arterial circulation," said Dr. Carl J. Lavie, medical director of cardiac rehabilitation at the Ochsner Heart and Vascular Institute in New Orleans.

Lavie, who was not involved with the study, cautioned, however, that "this data is probably not powerful enough to use statins just for this reason."

The findings also suggest that statins may derive some of their benefit from their effect on C-reactive protein, which has long been linked to inflammation. In fact, another study presented at the meeting concluded that, besides lowering cholesterol, part of the success of statins in reducing cardiovascular events can be attributed to the lowering levels of CRP.

Both studies are based on data from the landmark JUPITER trial, sponsored by the drug maker AstraZeneca, which markets Crestor (rosuvastatin). The first trial is being published early in the April 30 issue of the New England Journal of Medicine, while the second will appear in an upcoming issue of The Lancet.

A third study, to be presented at the ACC meeting on Monday, had less favorable findings. It found that giving Crestor to patients with end-stage kidney disease on dialysis did not lower their incidence of heart disease or heart deaths.

For the JUPITER trial, almost 18,000 men and women, average age 66, were randomly assigned to receive 20 milligrams of Crestor daily or a placebo. All the participants were "apparently healthy," with LDL cholesterol levels under 130 milligrams per deciliter of blood, and high-sensitivity C-reactive protein levels of 2 mg/liter or higher (slightly elevated). Just over a third of the participants were obese.

After a median follow-up of almost two years, Crestor was found to reduce the risk of blood clots in the veins (venous thromboembolism) by 43 percent compared to a placebo. The risk reduction was seen both in those without risk factors and those with risk factors for clots, such as people who were hospitalized, had cancer or who had undergone surgery, the study found.

There was no elevated risk of bleeding in people taking Crestor.

"We're very pleased that the drug seems to have this beneficial effect," said study author Robert J. Glynn, a biostatistician in the division of preventive medicine at Brigham and Women's Hospital in Boston. He added that the effect would probably also be seen in other statins.

The second trial found that participants who had reductions in both LDL and CRP levels had a reduction in vascular events that ranged from 65 percent to 79 percent.

But a third trial, released on Monday, found that daily Crestor offered no benefit in terms of reducing heart disease or heart death risk, for patients with end-stage kidney disease who were on dialysis. The AURORA study involved almost 2,800 patients ranging from 50 to 80 years of age, enrolled in more than 280 centers worldwide. These kidney dialysis patients received either Crestor at 10 milligrams per day or a placebo.

"While statins lowered LDL cholesterol by 43 percent -- roughly the same magnitude as expected in the general population -- and caused a small reduction in inflammation, this did not translate into prevention of cardiovascular death or morbidity," lead researcher Dr. Bengt Fellstrom, of University Hospital, Uppsala, Sweden, said in an ACC news release.

His team suspect that the lack of benefit was due to key differences between the types of heart disease seen in kidney disease patients and that seen among the general population.

Still, statins such as Crestor could be of real benefit to many people with heart risk factors, experts say. In fact, the JUPITER trial was halted early last year when researchers noted a 44 percent reduction in the risk of heart attack and stroke in the Crestor group.

The mechanisms by which statins lower clot risk aren't well understood, although some experts suspect the lowering of CRP may explain the decline.

"High CRP also has been a risk factor for developing arterial disease, and maybe the same now holds true for venous disease," Lavie said. "It supports the notion that cholesterol and/or CRP play a role in venous thromboembolic disease as well as arterial disease, and that statins appear to play a beneficial role in this as well."

Experts estimated that the original findings from the JUPITER trial -- that Crestor reduced the risk of heart attacks and stroke by 44 percent -- might add 11 million people to the already large population of older Americans taking statins.

So does this mean everyone will eventually be on statins to guard their heart health?

"It's an expensive drug, [and] it's always wrong to say take a pill and don't deal with your life. People need to exercise and change their diet," Glynn stressed.

More information

The U.S. National Library of Medicine has more on blood clots.

SOURCES: Robert J. Glynn, Sc.D., biostatistician, division of preventive medicine, Brigham and Women's Hospital, and associate professor, medicine, Harvard Medical School, Boston; Carl J. Lavie, M.D., medical director, cardiac rehabilitation and prevention, and director, Stress Testing Laboratory, Ochsner Heart and Vascular Institute, New Orleans; March 29, 2009, presentation, American College of Cardiology annual meeting, Orlando, Fla.; April 30, 2009, New England Journal of Medicine; The Lancet; March 30, 2009, news release, American College of Cardiology

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