Beauty Health for Life

Aggressive treatment with statins reduces the risk of subsequent cardiovascular events in patients with coronary artery disease even if they have very low LDL cholesterol levels, reveals research presented at ESC Congress 2013 today by Dr. Emi Nakano from Japan.

Dr Nakano said: "Many randomised clinical trials, such as Treating to New Targets (TNT) and PROVE IT-TIMI, have shown that aggressive cholesterol lowering with statins improves clinical outcomes in patients with CAD and high LDL-C levels.1,2 But until now it was not known whether aggressive lipid lowering with statins would also benefit CAD patients with very low LDL-C levels."

The current study used the Ibaraki Cardiovascular Assessment Study (ICAS), a registry of 2,238 patients from 12 hospitals in the Ibaraki region of Japan, who between 0 and 1 month underwent percutaneous coronary interventions. Based on serum LDL-C levels at initial presentation participants were classified into three groups: very low (<70 mg/dl, n=214); low (71-100 mg/dl, n=669); and high (>101 mg/dl, n= 1,355). Decisions of whether to prescribe statins or not, as well as the type and dose, were left to the discretion of treating physicians.

Patients were followed up for a maximum of 3 years. The efficacy of statin treatment was analysed on the composite outcome of Major Cardiovascular Events (MACE), defined as all cause mortality, non-fatal myocardial infarction and non-fatal stroke.

Statins were prescribed in 68% of patients (143) with very low LDL-C, 67% of patients (450) with low LDL-C and 67% of patients (913) with high LDL-C. A total of 204 patients experienced MACE during the median follow-up of 404 days.

The results of a Kaplan-Meier estimate show that three years of statin treatment produced significant reductions in the incidence of MACE in all three groups (p<0.001 for all groups). A Cox regression hazard analysis adjusted for age and gender showed that statins were the main determinant of better outcome regardless of the LDL-C level (p<0.01).

Dr Nakano said: "Our study shows that CAD patients with very low LDL-C levels at initial presentation also benefit from statin treatment. We speculate that statins prevent the enlargement of atherosclerotic plaques and plaque disruption in these patients."

She added: "Some doctors have been hesitant to prescribe statins in patients with very low LDL-C because of uncertain benefit and the risk of side effects with statins. But our findings suggest that all CAD patients should receive statins to reduce their risk of future cardiovascular events."

Dr Nakano concluded: "The next step should now be to initiate a randomised controlled trial of statin use in patients with CAD and very low LDL-C levels. This trial should be designed to confirm the benefits of statins for preventing future cardiovascular events in these patients, and to identify which type and dose of statins are most beneficial."

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Emerging evidence suggests many pregnant women are deficient in omega-3

Low levels of omega-3 may be behind postpartum depression, according to a review lead by Gabriel Shapiro of the University of Montreal and the Research Centre at the Sainte-Justine Mother and Child Hospital. Women are at the highest risk of depression during their childbearing years, and the birth of a child may trigger a depressive episode in vulnerable women. Postpartum depression is associated with diminished maternal health as well as developmental and health problems for her child. "The literature shows that there could be a link between pregnancy, omega-3 and the chemical reaction that enables serotonin, a mood regulator, to be released into our brains," Shapiro said. "Many women could bring their omega-3 intake to recommended levels." The findings were announced by the Canadian Journal of Psychiatry on November 15, 2012.

Because omega-3 is transferred from the mother to her fetus and later to her breastfeeding infant, maternal omega-3 levels decrease during pregnancy, and remain lowered for at least six-weeks following the birth. Furthermore, in addition to the specific biological circumstances of pregnant women, it has been found in the US that most people do not consume sufficient amounts of omega-3. "These findings suggest that new screening strategies and prevention practices may be useful," Shapiro said, noting that the study was preliminary and the further research would be needed to clarify the link and identify the reasons for it.