Leg function is better in individuals who take statins than in those who don't, and this benefit is independent of cholesterol levels, according to an observational study in the February 11, 2003 issue of Circulation.

The researchers assessed leg function and recorded statin use in 392 patients with peripheral arterial disease (ankle brachial index <0.90) and 249 patients without peripheral arterial disease (ankle brachial index 0.90 - 1.50)

In the analysis adjusted for confounders (age, sex, ankle-brachial index, comorbidities, education level, medical insurance status, cholesterol level, and others), statin users walked a significant 5% farther on a 6-minute walk test and walked a significant 4% faster on a 4-meter walking speed test than nonusers.

In addition, a summary score for leg function (based on walking speed, standing balance and time for repeated chair rises) was a significant 9% better in statin users as compared to nonusers.
 

The associations of statin use with walking speed and with summary score for leg function remained significant after additional adjustment for levels of C - reactive protein (Figures 1 and 2).
 

Early statin therapy restores endothelial function in children with familial hypercholesterolaemia. This finding underlines the relevance of statin therapy when familial hypercholesterolaemia is at a stage when the atherosclerotic process is still reversible, say specialists at the Emma Children's Hospital, Amsterdam, the Netherlands.
 

These results are from a study investigating if simvastatin improved endothelial function in 50 hypercholesterolaemic children, aged 9 to18 years. The study has been published in the January 2003 issue of Journal of the American College of Cardiology.

Measured by flow-mediated dilation of the brachial artery, endothelial function is used as a surrogate marker of cardiovascular disease. Adult studies have shown that it is reversed by statins, thus reducing the risk for future cardiovascular disease.

The children with familial hypercholesterolaemia were randomized to receive simvastatin or placebo for 28 weeks. Flow - mediated dilation was performed at baseline and at the end of treatment.
 

At baseline, flow-mediated dilation was impaired in the hypercholesterolaemic children compared with 19 healthy controls. In the hypercholesterolaemic children given simvastatin, flow - mediated dilation improved significantly, whereas in the hypercholesterolaemic children given placebo it was unchanged throughout the study (Figure 3).
 

Flow-mediated dilation increased to a level similar to controls in the simvastatin recipients.

The hypercholesterolaemic children given simvastatin showed significant absolute reductions of total cholesterol and low - density lipoprotein cholesterol.
 

The absolute change of flow - mediated dilation after 28 weeks of therapy was inversely correlated to changes of total cholesterol and low-density lipoprotein cholesterol.

In children with familial hypercholesterolaemia, the data showed "significant improvement" of endothelial dysfunction towards normal levels after short-term simvastatin therapy, the specialists concluded.
 

Statins May Increase Survival In Interstitial Pneumonitis

Another benefit of statins has been uncovered by a group of researchers who have demonstrated that it may increase survival in patients with interstitial pneumonitis.

These findings were presented here this week at the annual meeting of the American College of Chest Physicians (CHEST) in November 2002.

"We chose statins because they already had a well-documented impact on fibrosis in both cardiac tissue and renal tissue," said Martha S Burk, MD, from the department of internal medicine, division of pulmonary and critical care, Southern Illinois University School of Medicine, Springfield, Illinois, the United States. "So, we thought, assuming that this fibrotic cascade occurs in the same manner every organ system, they might also affect fibrosis in the lungs."

Dr. Burk and colleagues identified 57 patients diagnosed with or treated for interstitial pneumonitis at their center and affiliated hospitals between 1996 and 2000. All patients met the American Thoracic Society criteria for the disease. They excluded patients with a history of fibrogenic drug treatment, chest radiation, granulomatous disease, asbestosis, lung cancer and connective tissue disorders.

Among the 57 patients identified by the investigators, 18 had taken statins. Medications commonly taken by these patients for the treatment of interstitial pneumonitis included steroids, colchicine, azathioprine and cyclophosphamide. None of the patients had taken interferon-gamma. A Kaplan-Meier analysis revealed that, among all of these drugs, only use of statins had an impact on survival. Patients taking statins had a statistically significant increase in survival, with a relative risk of 0.16 (p=0.008).

The researchers acknowledge that this is a small, retrospective study, and it was not possible to control for many potentially confounding variables. Still, the data are compelling and call for further investigation into the role of statins in fibrotic lung disease.
 

Physicians have been concerned that statins, which are being increasingly prescribed to reduce blood cholesterol levels, might also decrease reproductive hormone levels and cause women of child-bearing age to be less fertile.
 

A study headed by researchers at Cedars - Sinai Medical Center in Los Angeles found that neither the use of statins nor low blood cholesterol levels significantly affected reproductive hormone levels in pre-, peri- or postmenopausal women. These findings are the subject of an article appearing in the December 2002 issue of the American Journal of Medicine.

A certain amount of cholesterol is necessary for the normal functioning of the body. In fact, reproductive hormones are derivatives of cholesterol, which led researchers to wonder if statins, which reduce blood cholesterol, might also reduce reproductive hormones.

According to C. Noel Bairey Merz, MD, the report's first author and the primary investigator of the study, "Although statins have been shown to be safe in clinical trials, fewer than 20 percent of trial participants have been women, and previous studies of the impact on reproductive hormones did not include premenopausal women of childbearing age."

The new study included 453 women with coronary risk factors who were undergoing coronary angiography at four academic medical centers in the United States. Of the total, 114 women were premenopausal. Data analyzed were drawn from an ongoing study, the Women's Ischemia Syndrome Evaluation (WISE), sponsored by the National Heart, Lung and Blood Institute.

The results showed that neither blood lipoprotein level nor use of statins was a significant independent predictor of reproductive hormone levels in models that adjusted for age, menopausal status, menstrual phase, and body mass index.

Although the results offer more reassurance that statin use is safe, Dr. Bairey Merz noted that the women in this sample were undergoing angiography for suspected myocardial ischemia and may not be representative of the general population. She said additional large-scale studies that would further reduce potential variables should be conducted, focusing particularly on women in their child-bearing years.