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ST. PAUL, Minn. – People who take cholesterol-lowering drugs called statins after a stroke may be less likely to have another stroke later, according to research published in the May 26, 2009, print issue of Neurology®, the medical journal of the American Academy of Neurology.

Those who take statins after a stroke may also be less likely to die within the next 10 years than those who do not take statins.

“Considering the large burden that stroke carries around the world, these potential benefits of statins are significant,” said study author Sotirios Giannopoulos, MD, DSc, of the University of Ioannina School of Medicine in Greece. “Also, second strokes tend to result in more disability and longer time spent in hospitals than first strokes, so anything that can prevent these recurrent strokes is beneficial.”

The study involved 794 people who had strokes and had health information available for 10 years after the stroke. Researchers looked back at the records to see what factors affected the risk for having a second stroke or dying within 10 years after the stroke.

During that time, 112 people had a second stroke and 224 people died. Those who took statins were 35 percent less likely to have a second stroke and 57 percent less likely to die within 10 years than those who did not take statins.

About eight percent of those on statins had a second stroke, compared to 16 percent of those not taking statins.

Researchers analyzed other risk factors for stroke, such as high blood pressure, diabetes, smoking, and heart problems, but found that statin use was the only factor tied to a reduced risk of recurrent stroke and death.

“It’s possible that effects from the drugs that are separate from their cholesterol-lowering effects are responsible for this result,” Giannopoulos said. “Statins have anti-inflammatory and antioxidative effects and also prevent blood clotting and stabilize plaque in the arteries, so one of these mechanisms may help to prevent recurrent stroke.”

Source: American Academy of Neurology

Elevated cholesterol levels return to normal or near normal levels over time in four out of 10 children with uncontrollable epilepsy treated with the high-fat ketogenic diet, according to results of a Johns Hopkins Children’s Center study reported in the Journal of Child Neurology. The study appears online ahead of print at http://jcn.sagepub.com/cgi/reprint/23/7/758.

In the four-year study, the Hopkins Children’s team followed 121 epileptic children with intractable seizures on the high-fat, low-carbohydrate ketogenic diet designed to control such seizures. While most children developed high cholesterol after starting the diet, cholesterol gradually improved in nearly half of them, returning to normal or near-normal levels, with or without modifications to their diet to reduce fat intake.

In fact, researchers point out, diet modifications-including reducing total fat content or certain types of fats called saturated fats and adding nutritional supplements-reduced high cholesterol just as much as doing nothing. High cholesterol is defined as total cholesterol greater than 200 mg per deciliter of blood, bad or LDL (low-density lipoprotein) cholesterol greater than 130, triglycerides greater than 130, and good or HDL (high-density lipoprotein) lower than 35.

Researchers prescribed dietary modifications to increase “good,” polyunsaturated fats in the diets of 15 children with elevated cholesterol. Dietary modifications decreased cholesterol by 20 percent in 9 out of the 15 (60 percent) children whose diets were modified. Surprisingly, cholesterol also dropped by at least 20 percent in 41 percent of the 37 children whose diets remained unchanged. The findings, while encouraging overall, also mean that relying on diet changes alone may not do much for those children in whom cholesterol remains persistently elevated, and that new approaches for these patients are needed, researchers say.

The findings should come as comforting news to pediatric neurologists, general pediatricians and parents of children treated with the ketogenic diet, and reassure them that, in most patients, increases in cholesterol may be short-lived, researchers say. Previous long-term studies by the Hopkins group of children who were on the diet between six and 12 years echoed these findings. The ketogenic diet, believed to work by triggering biochemical changes that eliminate seizure-provoking short-circuits in the brain’s signaling system, is used in many children with hard-to-control epilepsy and in those whose seizures do not respond to traditional anticonvulsant medications.

“We are greatly encouraged by our findings because the nearly half of the children on the diet were either able to maintain healthy cholesterol or gradually metabolized the extra fat and returned to somewhat normal cholesterol levels,” says senior investigator Eric Kossoff, M.D., a pediatric neurologist at Hopkins Children’s. “This means the benefits of the diet-a diet that is lifesaving in many children and therapeutic in most of them-continue to outweigh the risks.”

Noting that 40 percent of children maintained normal cholesterol even after starting the diet, researchers found that children fed a formula-based, liquid-only ketogenic diet were nearly three times less likely to develop high cholesterol. Researches attribute this finding to the nearly zero fat content in commonly used ketogenic diet formulas.

In the group with normal cholesterol, 78 percent of children (31 out of 40) were fed formula-based ketogenic diet. This finding, while requiring further study, points to another possible treatment for high cholesterol, Kossoff says, by switching children with persistently elevated cholesterol to formula-based ketogenic diets at least some of the time. The formula-based ketogenic diet contains only one-third the amount of saturated fats-the worst kind in terms of cholesterol-of the solid food version of the ketogenic diet. Because doctors can tweak the ratio of fat vs. carbohydrates depending on each child’s severity of seizures, the investigators examined whether higher-fat versions of the ketogenic diet raised cholesterol additionally, but found that higher-fat ratio did not make cholesterol worse than a lower-fat ratio.

Some of the other findings:

• One-fourth of 121 children had elevated total cholesterol before starting the diet, which increased to 60 percent (59 out of 99 children at follow-up) after the initiation of the diet.
• 18 percent (22 out of 119) had triglycerides over 130 before the diet, which increased to 51 percent (49 out of 96) after starting the diet.
• 19 percent (21 out 110) had bad cholesterol over 130 before the diet, which increased to 53 percent (48 out of 93) after starting the diet.

Source: Johns Hopkins Medical Institutions

Taking 1000mg of a specific olive leaf extract (EFLA®943) can lower cholesterol and lower blood pressure in patients with mild hypertension (high blood pressure). These findings came from a ‘Twins’ trial, in which different treatments were given to identical twins. By doing this, researchers could increase the power of their data by eliminating some of the uncertainties caused by genetic variations between individual people.

The research is published in the latest edition of Phytotherapy Research.

Hypertension is one of the most common and important disease risk factors imposed by the modern lifestyle. Many people would therefore benefit from finding ways of reducing blood pressure. Experiments in rats had previously indicated that olive leaf extract could be one way of achieving this goal.

To test this in humans, researchers from Switzerland and Germany conducted a pilot trial with 20 identical (monozygotic) twin pairs who had an increased blood pressure. Individuals were either given placebo capsules or capsules containing doses of 500mg or 1000mg of olive leaf extract EFLA®943. Pairs of twins were assigned to different treatments. After the subjects had taken the extract for eight weeks researchers measured blood pressures as well as collecting data about aspects of life-style.

“The study confirmed that olive leaf extract EFLA®943 has antihypertensive properties in humans,” says one of the co-authors, Cem Aydogan, General Manager, Frutarom Health.

“This works showed that taking a 1000mg dose has substantial effects in people with borderline hypertension,” says Aydogan.

Low levels of LDL cholesterol as well as high levels are associated with cancer in patients with type 2 diabetes, found a prospective cohort study http://www.cmaj.ca/press/pg427.pdf published in CMAJ.

Researchers from the Hong Kong Institute of Diabetes and Obesity, the Li Ka Shing Institute of Health Sciences and The Chinese University of Hong Kong conducted a study of 6107 Chinese patients with type 2 diabetes and found a V-shaped risk relation between LDL cholesterol and cancer in patients not receiving statin therapy.

“LDL cholesterol levels below 2.80 mmol/L and levels of at least 3.90 mmol/L were both associated with markedly elevated risk of cancer among patients who did not use statins,” state Dr. Juliana Chan and coauthors.

The study excluded people on statins as statins obscured the association between LDL cholesterol and all-site cancer.

Increasing data suggests an association between type 2 diabetes and an elevated risk of cancer, including breast, colorectal, pancreatic and liver cancers. An elevated risk of cancer in patients with low LDL was linked to cancers of digestive organs and peritoneum, genital and urinary organs, lymphatic and blood tissues as well as other areas. Patients with an LDL cholesterol level above 3.80 mmol/L had heightened risks of oral, digestive, bone, skin, connective tissue, breast and other cancers.

Regarding clinical implications, the authors suggest “the use of these levels as risk markers may help clinicians to assess their patients more fully and thus to prevent premature deaths in patients who have high risk.”

They call for re-analysis of data from clinical trials to confirm or refute these findings.

In a related commentary, Drs. Frank Hu and Eric Ding of Harvard School of Public Health (Todd Datz, Public Relations, Harvard School of Public Health, 617-432-3952 for Dr. Frank Hu) say confounding factors such as indication for the use of statins, lifestyle and socioeconomic status must be considered when looking at the association of high levels of LDL cholesterol and the risk of cancer.

“Low serum cholesterol is commonly observed in individuals with ill health (e.g. cancer patients) and those with unhealthy lifestyle characteristics such as smoking and heavy drinking,” states Hu.

Source: Canadian Medical Association Journal

UC San Diego researchers advocate intervention beginning in childhood

With heart disease maintaining top billing as the leading cause of death in the United States, a team of University of California, San Diego School of Medicine physician-researchers is proposing that aggressive intervention to lower cholesterol levels as early as childhood is the best approach available today to reducing the incidence of coronary heart disease.

In a review article published in the August 5, 2008 issue of the American Heart Association journal Circulation, pioneering lipid researcher Daniel Steinberg, M.D., Ph.D., professor emeritus of medicine at UC San Diego, and colleagues Christopher Glass, M.D., Ph.D. and Joseph Witztum, M.D., both UC San Diego professors of medicine, call current approaches to lowering cholesterol to prevent heart disease “too little, too late.”

They state that with a large body of evidence proving that low cholesterol levels equate with low rates of heart disease, “…our long-term goal should be to alter our lifestyle accordingly, beginning in infancy or early childhood” and that “…instituting a low-saturated fat, low-cholesterol diet in infancy (7 months) is perfectly safe, without adverse effects…”

According to Steinberg, progress has been made in the treatment of coronary heart disease in adults with cholesterol lowering drugs like statins. However, while studies show a 30% decrease in death and disability from heart disease in patients treated with statins, 70% of patients have cardiac events while on statin therapy. Promising new therapies are under development, but with an alarming rate of coronary heart disease in the U.S. today, action to curtail the epidemic is needed today.

In fact, they propose that lowering low-density lipoproteins (the so-called “bad cholesterol”) to less than 50 mg./dl. even in children and young adults is a safe and potentially life-saving standard, through lifestyle (diet and exercise) changes if possible. Drug treatment may also be necessary in those at very high risk.

“Our review of the literature convinces us that more aggressive and earlier intervention will probably prevent considerably more than 30% of coronary heart disease,” said Steinberg. “Studies show that fatty streak lesions in the arteries that are a precursor to atherosclerosis and heart disease begin in childhood, and advanced lesions are not uncommon by age 30. Why not nip things in the bud?” Such early signs of heart disease should be taken as seriously as early signs of cancer or diabetes, he said.

Physicians have been slow to measure cholesterol, much less prescribe cholesterol lowering regimens in children and young adults who are otherwise healthy. However, the UC San Diego team notes that studies of Japanese men in the 1950s showed that consuming a low-fat diet from infancy resulted in lifelong low cholesterol levels, and their death rate from heart disease was only 10% of the rate of cardiac-related death in the U.S. Even with risk factors such as cigarette smoking and diabetes, heart disease deaths remained significantly lower in Japanese men with lifetime levels of low cholesterol. This protective effect was lost in Japanese who migrated to the United States and adopted a Western diet leading to higher blood cholesterol levels.

Interventions today typically begin in adults diagnosed with high cholesterol levels or other risk factors or symptoms of coronary artery disease. However, initiating cholesterol-lowering interventions in 50-year-old adults, even if successful, is unlikely to reverse established arterial disease and will therefore have limited impact on the occurrence of adverse events related to coronary heart disease.

Citing the success of lowering cholesterol levels in children diagnosed with familial hypercholesterolemia, the UC San Diego team suggests that programs to lower cholesterol in the population at large from childhood on, with the ideal LDL level set at 50 mg./dl. or less (in those at highest risk), will have a long-term beneficial effect and lower the nationwide rates of coronary artery disease. They do not advocate using drug therapy to reach these levels, especially in children with no other risk factors, but to achieve these low levels through “TLC,” or “therapeutic lifestyle changes,” such as diet and exercise.

The National Institutes of Health (NIH) has declared “war” against the parallel epidemics of obesity and diabetes. The researchers conclude that “The weapons for those wars—education and behavior modification—are the same as those needed for a ‘war’ on coronary heart disease.”

They propose that “A concerted national effort might dramatically reduce morbidity and mortality due to three major chronic diseases…It would take generations to achieve and it would require an all-out commitment of money and manpower to reeducate and modify the behavior of a nation. Is that impossible? No. We have already shown that even a frankly addictive behavior like cigarette smoking can be overcome (eventually).”

Source: University of California – San Diego