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[IP] Cholesterol Drug Cuts Diabetes, Stroke Risk

Cholesterol Drug Cuts Diabetes, Stroke Risk 
Jan. 23, 2001- (HealthScout) -- Pravastatin, a cholesterol-lowering drug, 
reduces the risk of having a stroke and developing diabetes, epidemiologists 
But those reports, based on studies of thousands of patients, leave two major 
questions to be answered: How does the drug produce its beneficial effects? Do 
other drugs in the widely used statin family have the same preventive action? 
More than a half-dozen statin drugs now are available. Pravastatin, marketed 
as Pravachol by Bristol-Meyers Squibb, is one of them. Others include 
atorvastatin (Lipitor), cerivastatin (Baycol), fluvastatin (Lescol), 
lovastatin (Mevacor) and simvastatin (Zocor). 
The new report is the latest example of good news about the beneficial side 
effects of statins. Last November, epidemiologists reported a notable decrease 
in the incidence of Alzheimer's disease and other dementias in persons taking 
several of the cholesterol-lowering drugs. 
The finding about pravastatin and stroke comes as a surprise because "until 
these studies were done, the general medical feeling was that using a 
lipid-lowering agent does nothing to reduce the stroke rate," says Robert P. 
Byington, professor of epidemiology at Wake Forest University School of 
Medicine and lead author of a paper in the Jan. 23 issue of Circulation: 
Journal of the American Heart Association . 
His report was based on data from three studies of nearly 20,000 patients in 
the United States, Scotland, Canada and Australia who had suffered heart 
attacks or had been hospitalized with severe chest pain. Half were prescribed 
pravastatin and half received a placebo, an inactive substance. 
Over five years, the pravastatin patients had a 20 percent reduced risk of 
stroke compared to those receiving the placebo, and the protective effect 
applied across the board, Byington says. 
"The advantage of the kind of analysis I did is that when you pooled the data 
from three individual trials you could stratify the findings by age, gender, 
smoking habits, lipid levels and whether people were taking drugs to lower 
blood pressure," Byington says. "In each one of those cases, you had a 
reduction in stroke rate." 
Diabetes benefit found by chance 
A second report in Circulation comes from the University of Glasgow in 
Scotland, where a group led by Dr. Allan Gaw analyzed data from the West of 
Scotland Coronary Prevention Study, designed to determine the effectiveness of 
pravastatin in preventing first heart attacks in people with high cholesterol. 
But they found an accidental benefit. Of the 5,974 men in the study, 153 
developed diabetes. The incidence of diabetes was 30 percent lower in those 
taking pravastatin than in the men who received a placebo. 
The reported reduction is "an exciting finding," says Dr. Daniel Levy, 
director of the National Heart, Lung and Blood Institute's Framingham Heart 
Study, but because of the small numbers of patients, "it requires validation." 
A number of ongoing trials of pravastatin and other statins can provide that 
validation, he says. 
"In general, what applies to one statin tends to apply to other members of the 
class," Levy says, but again that general statement must be validated by other 
There are several possible ways in which statins might work to prevent 
diabetes, Levy says. One is their ability to reduce blood levels of 
triglycerides, fats known to be associated with diabetes. 
"A second mechanism may be through their anti-inflammatory properties," he 
says. "Third, it may be because of their effect on the function of 
endothelium, the lining of blood vessels." 
While studies go on, Byington has some cautious, limited advice on statin 
therapy: "If you have evidence of a heart attack or severe angina, this 
specific agent is worth taking." 
What To Do 
Anyone who thinks about taking a statin drug for other than its accepted 
indication, reduction of blood cholesterol levels, should talk to a physician 
about the unknowns of the medication and possible side effects. 
Try the American Heart Association to learn more about cholesterol-reducing 
drugs. Meanwhile, the American Diabetes Association has a primer on that 
disease, while the National Stroke Association can teach you about brain 
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