Latest news with #statins
Medscape
2 days ago
- Health
- Medscape
What Is Lp(a), and When Should We Check It?
In this podcast, I'm going to talk about what we need to know about lipoprotein (a), or Lp(a), and atherosclerotic cardiovascular disease in primary care. Lp(a) is an important but underappreciated independent risk factor for atherosclerotic cardiovascular disease. As we all know, atherosclerotic cardiovascular disease is a chronic, progressive condition characterized by the accumulation of lipids, inflammatory cells, and other cells in arteries that results in the formation of atherosclerotic plaques. As these plaques build up and rupture, they cause partial or complete obstruction of blood flow, tragically leading to clinical events such as myocardial infarctions or ischemic strokes. I'm sure all of us in primary care can sadly recall individuals who have suffered heart attacks or strokes who appeared to be very healthy, with no obvious cardiovascular risk factors. We all know that elevated LDL cholesterol levels (or bad cholesterol) are a proven and direct cause of atherosclerotic cardiovascular disease, and it has been estimated that for each 1 mmol/L reduction in LDL cholesterol, there's a relative risk reduction of 23% for major cardiovascular events. Well, Lp(a) is an LDL-like particle that is an independent, genetically determined risk factor for major cardiovascular events and cardiovascular mortality. But unlike LDL cholesterol, Lp(a) levels are not significantly affected by lifestyle choices or statins. Lp(a) is found in atherosclerotic plaques and has proinflammatory, prothrombotic, and proatherogenic effects driving that progression of atherosclerosis. Epidemiological and genetic studies strongly support a causal and continuous association between Lp(a) levels and cardiovascular outcomes. In fact, Lp(a) is a risk factor even at very low levels of LDL cholesterol. Lp(a) is also an independent risk factor for calcific aortic stenosis. So, how common are elevated Lp(a) levels? Well, around 1 in 5 people globally are at high risk of developing atherosclerotic cardiovascular disease due to elevated Lp(a) levels. However, there are differences with regard to Lp(a) levels across different ethnicities. Black individuals are more likely to have elevated Lp(a) than White, Hispanic, or Asian individuals. Importantly, Lp(a) levels are inherited in a predominantly autosomal dominant manner, which means a child of an affected parent with high Lp(a) levels has a 50% chance of being affected him- or herself. So, what levels of Lp(a) drive an increased risk of atherosclerotic cardiovascular disease? Levels of 32-90 nmol/L confer a minor risk. Levels between 90 and 200 nmol/L confer a moderate risk. Levels of 200-400 nmol/L confer a high risk, and levels greater than 400 nmol/L confer a very high risk. Lp(a) levels need to only be measured once in a lifetime, unless a specific treatment is being undertaken to lower levels, which I will discuss shortly. Heart UK, the UK cholesterol charity, published a consensus statement and call to action on Lp(a) during 2019 that included some useful, pragmatic recommendations for all of us working in primary care. Notably, this consensus gave a number of recommendations on when we should consider checking Lp(a) levels. We should consider checking Lp(a) levels in those with a personal or family history of premature atherosclerotic cardiovascular disease, particularly under the age of 60 years. We should consider checking levels in those with a first-degree relative with high Lp(a) levels over 200 nmol/L. We should consider checking levels in those with a history of familial hypercholesterolemia or another genetic dyslipidemia. We should consider checking levels in those with a background of calcific aortic valve stenosis. And we should also consider checking levels in those with a borderline increased 10-year cardiovascular risk of around about 10% to 15%. This is to aid reclassification of these individuals at intermediate risk of atherosclerotic cardiovascular disease and hopefully encourage acceptance of LDL cholesterol-lowering therapies such as statins. So, how do we manage elevated Lp(a) levels? Currently, there are no approved therapies to treat elevated Lp(a) levels. The most effective therapy for high Lp(a) levels is apheresis, which is a blood filtering process like dialysis. This procedure is reserved for the highest risk individuals, as it is very expensive, requires weekly visits to the apheresis center, and is not without harm. However, newer therapies targeting Lp(a) directly are in development, which will transform the management of high-risk individuals. So, what can we do meanwhile in primary care for those with high Lp(a) levels? We need to mitigate overall cardiovascular risk with aggressive lipid management and targeting of all other cardiovascular risk factors. For those with Lp(a) levels greater than 90 nmol/L (moderate risk and above), we should initiate a high-intensity statin and aim for a greater than 50% reduction in non-HDL cholesterol and an LDL cholesterol of less than 1.8 mmol/L liter or non-HDL cholesterol level of less than 2.5 mmol/L. We should also consider referral to a specialist lipid clinic for those with high-risk Lp(a) levels (greater than 200 nmol/L) but manage all cardiovascular risk factors while waiting for them to be seen. Cascade screening and family should also be offered to individuals with a familial or personal history of high Lp(a) levels or an early history of atherosclerotic cardiovascular disease in the family under the age of 60 years. So, a call to action for us all in primary care: Lp(a) is an independent, genetically determined risk factor for atherosclerotic cardiovascular disease that is not significantly affected by lifestyle choices or statins. We should consider checking Lp(a) levels in those with a personal or family history of premature atherosclerotic cardiovascular disease under the age of 60 years, in those with calcific aortic valve stenosis, or in those where an atherosclerotic event has occurred with no obvious underlying risk factors. Finally, I produced a Medscape UK primary care hack or clinical aide-mémoire on lipid management for the primary and secondary prevention of cardiovascular disease for healthcare professionals. I hope you find this resource helpful. Medscape Family Medicine © 2025 WebMD, LLC Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. Cite this: What Is Lp(a), and When Should We Check It? - Medscape - Jul 10, 2025.
Health Line
01-07-2025
- Health
- Health Line
What's the Connection Between Statins and Dementia?
There are conflicting research findings as to whether the use of statins can protect from dementia or increase the risk of dementia. While some older research has pointed to the possibility of a correlation, more recent studies showed that this drug class may lower your risk for dementia, including Alzheimer's disease. Statins are a type of medication taken to lower cholesterol levels in the blood. They prevent an enzyme called hydroxymethylglutaryl-CoA reductase (HMG-CoA reductase), which is involved in the production of cholesterol in the liver. Benefits of statins Benefits include lowering LDL ('bad') cholesterol levels, reducing the risk of heart disease, and preventing plaque buildup in your arteries. These medications include atorvastatin (Lipitor) and rosuvastatin (Crestor), among others. In 2012, the Food and Drug Administration issued a warning that statin use could rarely cause memory loss or confusion. The FDA later updated the findings that this cognitive decline was not significant. A growing body of research suggests statins may have a protective effect against dementia. A review of 31 studies published in 2018 supports the idea that statins can help prevent the risk of dementia. The researchers found that taking statins for 1 year decreased dementia risk by about 20%, while an average daily 5-milligram (mg) dose was associated with an 11% decrease in dementia risk. The researchers noted that because high cholesterol is a risk factor for dementia, lowering it could have positive effects on the brain. According to a 2020 review, statins may help short- and long-term delay of dementia progression in people over 65 years old with the condition, although the researchers noted that their findings were insufficient to make a definitive statement. Studies in 2021 and 2023 also pointed in the direction of statins having a protective effect against dementia, though the results were not conclusive. Research discrepancies Researchers in a 2022 study pointed out that discrepancies among studies is possibly related to smaller sample sizes and biases in the research methods, as well as wide ranges in the ages of participants, and co-existing conditions. Additionally, these researchers pointed out that different types of statins have different cognitive effects. Most scientists and medical professionals agree that more research is needed on the cognitive effects of statins, and there are studies in progress. If you have high cholesterol, it's important to get advice from a medical professional. High cholesterol is a risk factor for diseases that can affect your independence and life span, such as: heart disease dementia stroke heart attack While some people can experience improvement with lifestyle modifications, many who have high cholesterol need to take cholesterol-lowering medication. You and your doctor can discuss a plan that's individualized for you.
The Sun
13-06-2025
- Health
- The Sun
Ozempic-like weight loss jabs could one day be dished out like statins, says top NHS doctor
WEIGHT loss jabs could one day be dished out like statins, England's top doctor says. Professor Sir Stephen Powis, medical director of NHS England, said in years to come they will get cheaper and may be used to prevent a range of illnesses. But chief medical officer Professor Sir Chris Whitty said they are 'not a get out of jail card' and people must still try to be healthy. GPs will roll out Mounjaro across the country from this month. The injections currently cost the NHS around £100 each but prices are expected to drop over time. Research increasingly shows they have health benefits beyond diabetes and weight loss, potentially including reducing the risks of cancer, dementia and heart diseases. Cholesterol -lowering statins have been used for decades to reduce heart attacks and strokes and now cost next to nothing at 3p a pill. Studies suggest they also reduce the risk of dementia, though it is not what they were designed for. Prof Powis said: 'The use of statins is now very different from when they first came out and I've no doubt that will be the same for these drugs. 'I think over time it's highly likely that they will become more widespread. 'I think there will be a combination of increased evidence of positive outcomes and costs dropping, and we will learn better how to deploy them. 'It's not completely unusual for drugs over time to be found to have effects that go over and beyond what they were initially designed for. 'I am not starry-eyed about weight loss drugs but it's very exciting. 'We're in the foothills of learning how to use them.' NHS prescriptions surging NHS use of the jabs is already skyrocketing and official figures show prescriptions in England surged from 1.4million in 2023 to 2.7m in 2024. Doctors spent a total of £269million on them in the latest financial year and more than a million people are estimated to be buying them privately. Prof Whitty said it is important for people to still get help to eat healthily and exercise, as well as taking medicine. He added: 'These are not get out of jail cards. 'What we shouldn't do is use it as an excuse, as a society, not to deal with what is a rising and very serious problem.' Everything you need to know about fat jabs Weight loss jabs are all the rage as studies and patient stories reveal they help people shed flab at almost unbelievable rates, as well as appearing to reduce the risk of serious diseases. Wegovy – a modified version of type 2 diabetes drug Ozempic – and Mounjaro are the leading weight loss injections used in the UK. Wegovy, real name semaglutide, has been used on the NHS for years while Mounjaro (tirzepatide) is a newer and more powerful addition to the market. Mounjaro accounts for most private prescriptions for weight loss and is set to join Wegovy as an NHS staple this year. How do they work? The jabs work by suppressing your appetite, making you eat less so your body burns fat for energy instead and you lose weight. They do this my mimicking a hormone called GLP-1, which signals to the brain when the stomach is full, so the drugs are officially called GLP-1 receptor agonists. They slow down digestion and increase insulin production, lowering blood sugar, which is why they were first developed to treat type 2 diabetes in which patients' sugar levels are too high. Can I get them? NHS prescriptions of weight loss drugs, mainly Wegovy and an older version called Saxenda (chemical name liraglutide), are controlled through specialist weight loss clinics. Typically a patient will have to have a body mass index (BMI) of 30 or higher, classifying them as medically obese, and also have a weight-related health condition such as high blood pressure. GPs generally do not prescribe the drugs for weight loss. Private prescribers offer the jabs, most commonly Mounjaro, to anyone who is obese (BMI of 30+) or overweight (BMI 25-30) with a weight-related health risk. Private pharmacies have been rapped for handing them out too easily and video calls or face-to-face appointments are now mandatory to check a patient is being truthful about their size and health. Are there any risks? Yes – side effects are common but most are relatively mild. Around half of people taking the drug experience gut issues, including sickness, bloating, acid reflux, constipation and diarrhoea. Dr Sarah Jarvis, GP and clinical consultant at said: 'One of the more uncommon side effects is severe acute pancreatitis, which is extremely painful and happens to one in 500 people.' Other uncommon side effects include altered taste, kidney problems, allergic reactions, gallbladder problems and hypoglycemia. Evidence has so far been inconclusive about whether the injections are damaging to patients' mental health. Figures obtained by The Sun show that, up to January 2025, 85 patient deaths in the UK were suspected to be linked to the medicines.
Telegraph
12-06-2025
- Health
- Telegraph
Weight-loss drugs could become as common as statins, says England's top doctor
Weight-loss jabs could eventually be doled out like statins, England's top doctor has said. Prof Sir Stephen Powis, medical director of the NHS, said the health service should consider the mass rollout of medication to 'turn the tide' on Britain's obesity crisis. The NHS has been criticised for tightly rationing the jabs, having drawn up a plan for a 12-year rollout. GPs in England will start prescribing the injections from this month, but only to those with severe obesity and at least one weight-related health problem. Until now, jabs have only been available via specialist services with long waiting lists. However, NHS pilot schemes will look at ways to roll them out far more widely, including offering jabs through the post, from online pharmacies. Statins are one of the most commonly prescribed drugs in the UK, with about eight million people taking them to cut their chance of a heart attack and stroke. An estimated 1.5 million people are taking weight-loss jabs in the UK, with the vast majority paying for them privately, at around £200 a month. 'Exciting milestone' Speaking at the NHS ConfedExpo conference in Manchester, Sir Stephen hailed the rollout in GP surgeries as an 'exciting milestone' and said NHS officials are also examining ways to ' broaden access to the drugs '. Around 29 per cent of adults in the UK are obese. Sir Stephen said: 'Right now, obesity is estimated to cost the NHS approximately £11.4 billion every year – this financial burden is unsustainable for the NHS and wider economy. 'We have to turn the tide. We have to and will go further, and faster. 'In just a few years from now, some of today's weight-loss drugs will be available at much lower cost. This could completely transform access to these innovative treatments. 'But we will and must be guided by the evidence base and must do this safely and sustainably, in a way that ensures that we are equipped as a health service to deal with the demand.' 'We'll learn how to deploy them better' Sir Stephen said that the 'exciting new class of medication' would see wider rollout in the same way that statins had been rolled out en masse. 'There will be more drugs coming on the market. There will be different prices for drugs. We will get to generics, which means that prices will fall,' he said. 'We have been through this over statins, and the use of statins is now very different from when they first came out, and I've no doubt that will be the same for these drugs. So it's very exciting.' The senior doctor said research suggesting they can prevent and treat multiple diseases, including heart and kidney disease, also meant they were like statins. 'It's highly likely that they will become more widespread, the evidence base will increase. We will learn better how to deploy them,' he said.
Medscape
09-06-2025
- Health
- Medscape
Low-Dose Colchicine May Help Stabilize Coronary Plaques
The LoDoCo2 trial found a reduced cardiovascular risk with low-dose colchicine in patients with chronic coronary disease. In this substudy, attenuation of pericoronary adipose tissue did not differ between patients receiving low-dose colchicine and those receiving placebo; however, people taking colchicine had a higher volume of dense calcified plaque, indicating improved plaque stability. METHODOLOGY: Elevated attenuation of pericoronary adipose tissue and a high burden of noncalcified plaque have been linked to adverse coronary outcomes caused by plaque rupture and instability; statins mitigate these risks by promoting plaque calcification. This cross-sectional substudy of the LoDoCo2 trial investigated if treatment with low-dose colchicine would attenuate coronary inflammation, as evidenced by less attenuation of pericoronary adipose tissue in 151 patients with chronic coronary disease (mean age, 64.4 years; 14% women). Patients were randomly assigned to receive either low-dose colchicine (0.5 mg once daily; n = 79) or placebo (n = 72). All patients had previously undergone coronary stenting at enrollment and were on antiplatelet and/or anticoagulant therapy; high-intensity statin therapy consisted of 40 mg and 80 mg doses of atorvastatin. After a median treatment duration of 28 months, coronary CT angiography (CCTA) was performed to evaluate the attenuation of pericoronary adipose tissue in the proximal segments of epicardial coronary arteries and to assess plaque characteristics. TAKEAWAY: Median attenuation did not differ significantly between the patients receiving colchicine and those receiving placebo. Compared with patients receiving placebo, those receiving colchicine showed a higher calcified plaque burden (adjusted difference, 2.4%), higher calcified plaque volume (adjusted difference, 59 mm 3 ), and higher volume of dense calcified plaque (adjusted difference, 61.5 mm 3 ; P < .05 for all). ), and higher volume of dense calcified plaque (adjusted difference, 61.5 mm ; < .05 for all). In patients on low-intensity statin therapy, colchicine treatment was associated with a lower burden of low-attenuation plaque, an effect not observed in those receiving high-intensity statins ( P for interaction = .037). IN PRACTICE: Low-dose colchicine was associated with an overall higher volume of calcified plaque, particularly dense calcified plaque, as well as a lower burden of low-attenuation plaque in participants treated with colchicine and low-intensity statins,' the researchers wrote. 'Although the cross-sectional design of the study limits causal inference, these are features of plaque stability and may partly explain the reduction in risk of cardiovascular events associated with colchicine in patients with chronic coronary disease.' SOURCE: This study was led by Aernoud T L Fiolet, MD, PhD, of University Medical Centre Utrecht, Utrecht, the Netherlands. It was published online on May 19, 2025, in Heart . LIMITATIONS: The researchers conducted this cross-sectional analysis at the end of treatment, without any baseline or temporal studies. This study had relatively fewer women than the proportion of women with cardiovascular disease in the general population. Additional imaging modalities were not used to confirm the findings from CCTA. DISCLOSURES: This study received grants from the Australian National Institutes of Health/National Heart, Lung, and Blood Institute, Withering Stichting Nederland, the Netherlands Heart Foundation, and the Netherlands Organisation for Health Research and Development. One author reported receiving software royalties from Cedars-Sinai Medical Center. Another author reported giving presentations, and three authors reported serving as consultants for pharmaceutical and healthcare companies without receiving any personal fees.
