Goltz syndrome gene found

Researchers funded in part by the National Institutes of Health have identified the gene that accounts for most cases of Goltz syndrome, a rare skin disorder that can also affect bone and eye development.
The cases appear to result from a defect in the gene known as PORCN, which contains the information needed to make a protein, referred to by researchers as porcupine. The Porcupine protein, which was first identified in fruit flies, was named for the pattern of spikes projecting from skin cells of the larval fly’s body, bearing a resemblance to the quills of a porcupine.

The researchers believe mutations in the PORCN gene cause at least 75 percent of Goltz syndrome cases.

“Identifying a genetic mutation for Goltz syndrome is a critical first step in understanding and eventually treating the condition,” said Duane Alexander, director of the National Institute of Child Health and Human Development, the NIH institute that provided funding for the Mental Retardation and Developmental Disabilities Research Center at Baylor College of Medicine, where the study was conducted.

The study was lead jointly by Xiaoling Wang, Department of Obstetrics and Gynecology at Baylor College of Medicine, and V. Reid Sutton, Department of Molecular and Human Genetics at Baylor College of Medicine.

The findings were published online in Nature Genetics .

Goltz syndrome, also called focal dermal hypoplasia, causes a distinctive red rash and thinning of the skin, which allows fat from the tissue below to protrude and form small yellowish-white lumps.

The disorder often causes brittle hair and nails, and deformities in the hands, such as extra, missing, or deformed fingers. Individuals with Goltz syndrome can also have missing or underdeveloped eyes. In addition, the disorder can affect the stomach, intestines, heart, lungs, and kidneys, said Dr. Ignatia B. Van den Veyver, associate professor at Baylor College of Medicine’s Departments of Obstetrics and Gynecology and of Molecular and Human Genetics and the senior author of the paper. Mental retardation is seen in about fifteen percent of patients with Goltz syndrome.

Because 90 percent of Goltz syndrome cases are seen in females, the disorder was believed to be caused by a gene on the X chromosome. After analyzing the genes of two girls with Goltz syndrome, the researchers found that both patients were missing a portion of the X chromosome where seven genes are located. Of the missing seven, the researchers learned that Goltz syndrome resulted from an absence of the PORCN gene, said Dr. Van den Veyver.

The PORCN gene is active in the embryo and fetus, creating proteins important in the development of the skin, skeleton, and eyes – all affected in the disorder.

Researchers then did genetic analyses of 15 girls with Goltz syndrome and found that the PORCN gene was affected in 10 of them.

Although the PORCN gene has been studied in mice and fruit flies, very little is known about the gene’s function in humans, said Dr. Van den Veyver. The mouse and Drosophila porcupine proteins are known to be important for the secretion of Wnt proteins from the cells that produce them. Wnt proteins are involved in early development. They interact with other proteins within the cell to begin the complex chain of events leading to the development and differentiation of organ systems in early life.

This discovery may lead to greater understanding of the function of Wnt proteins in humans, said Dr. Van den Veyver.

By identifying the genetic defect which causes Goltz syndrome, it may be possible to understand more of the processes critical for skin, eye and bone development, she said.

“The findings are important because they offer insight into a developmental disorder that was previously little understood,” said Ljubisa Vitkovic, M.D., of NICHD’s Mental Retardation and Developmental Disabilities Branch. “But they also illustrate how a mutation in the human counterpart of a protein known to regulate development in flies and mice can affect the skin and other human organs.”

Source : www.news-medical.net

Estrogen Therapy In Younger Postmenopausal Women Linked To Less Plaque In Arteries

New results from a substudy of the Women’s Health Initiative (WHI) Estrogen-Alone Trial show that younger postmenopausal women who take estrogen-alone hormone therapy have significantly less buildup of calcium plaque in their arteries compared to their peers who did not take hormone therapy. Coronary artery calcium is considered a marker for future risk of coronary artery disease.

Results of the WHI Coronary Artery Calcium Study are published in the June 21, 2007, issue of the New England Journal of Medicine. The WHI is sponsored by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.

“These new results offer some reassurance to younger women who have had a hysterectomy and who would like to use hormone therapy on a short-term basis to ease menopausal symptoms,” noted Elizabeth G. Nabel, M.D., NHLBI director. “We must emphasize, however, that these findings do not alter the current recommendations that when hormone therapy is used for menopausal symptoms, it should only be taken at the smallest dose and for the shortest time possible, and hormone therapy should never be used to prevent heart disease.”

The new findings are from an ancillary study of 1064 women who were 50-59 years of age at the start of the WHI hormone therapy clinical trial. Participants were randomly assigned to either 0.625 milligrams per day of conjugated equine estrogens (Premarin™) or placebo (inactive pill). Participants took assigned medication for an average of nearly seven and one-half years. After slightly more than one year after treatment ended, researchers used computed tomography (CT scan) to measure the level of calcium plaque in the women’s coronary arteries. Those who had taken estrogen were 30 to 40 percent less likely to have measurable levels of coronary artery calcium compared to those on placebo.

“Although our findings lend support to the theory that estrogen may slow early stages of plaque build-up in the coronary arteries, estrogen has complex effects and other known risks,” said JoAnn Manson, M.D., chief of Preventive Medicine at Harvard’s Brigham and Women’s Hospital and lead author of the paper. “The results are consistent with our earlier findings that younger women treated with estrogen had a trend toward fewer heart attacks but, for an individual woman, it remains uncertain whether the benefits of estrogen would outweigh the risks. For this reason, estrogen should not be used for the express purpose of preventing cardiovascular disease, but it may be appropriate for the short-term treatment of moderate-to-severe hot flashes or night sweats among recently menopausal women.”

In February 2006, WHI researchers reported that among the women in the estrogen-alone trial who were 50-59 years of age at study entry, women in the estrogen group had a non-significant trend towards lower rates of heart attacks compared to the placebo group, and significantly fewer women in the estrogen group required procedures to re-open clogged arteries. There was no suggestion of cardiovascular benefit in women who were 60 years or older.

“Heart attacks are uncommon among younger women, and the more relevant question is about long-term benefit as women grow older,” noted Jacques Rossouw, M.D., chief of the NHLBI Women’s Health Initiative Branch. “Conducting a clinical trial that would start any form of hormone therapy on postmenopausal women at a younger age and follow them for decades – when they would be more likely to have heart attacks – is not feasible.

“We cannot assume that any possible short-term, cardiovascular benefit from hormone therapy to postmenopausal women in their fifties would extend into older ages if they were to continue using hormones,” Rossouw cautioned. “We already know that starting hormone therapy in older women increases their risk of heart disease. And long-term hormone therapy has other risks such as strokes and blood clots, and, with the use of combination therapy, breast cancer.”

The WHI is a major, 15-year research program designed to address the most frequent causes of death, disability, and poor quality of life in postmenopausal women: cardiovascular disease, cancer, and osteoporosis. The principal findings from the WHI hormone therapy trials, which studied 27,347 postmenopausal women on estrogen-alone or estrogen plus progestin, found that the overall risks of hormone therapy outweigh the benefits. Both of these trials were stopped early because of increased health risks and failure to prevent heart disease, a key question of the studies. Even though the risks for coronary heart disease were less pronounced in the estrogen alone trial than in the estrogen-plus-progestin trial, both therapies increased the risk of stroke and of blood clots.

Overall, the estrogen-alone study involved 40 clinical centers and 10,739 generally healthy postmenopausal women ages 50-79 who did not have a uterus. The clinical trial was stopped in February 2004 after approximately 7 years of follow up because of increased risk of stroke and no reduction in risk of coronary heart disease. The study also found an increased risk of blood clots.

The estrogen-plus-progestin study (conducted in postmenopausal women with a uterus) was stopped in 2002 due to an increase in breast cancer. Like estrogen-alone, combination hormone therapy was also found to increase the risk of stroke and blood clots regardless of the women’s age or time since menopause. Combination therapy was also found to increase the risk of heart disease in the first few years.

All women who wish to lower their risk of heart disease should make healthy lifestyle choices, such as following a diet low in sodium, saturated fat, transfat and cholesterol; maintaining a healthy weight; engaging in regular physical activity; and not smoking. In addition, they should work with their healthcare provider to identify and manage other known risk factors such as high blood pressure, high blood cholesterol, and diabetes.

Source : www.medicalnewstoday.com

Extended Duration Work Shifts Risky To The Safety, Well-Being Of Medical Interns, Patients

Working an extended duration shift can pose a risk to not only the safety and well-being of medical interns, but also to that of their patients, according to a research abstract presented at SLEEP 2007, the 21st Annual Meeting of the Associated Professional Sleep Societies (APSS).

The study, authored by Laura Barger, PhD, of Brigham and Women’s Hospital in Boston, was based on 2,737 physicians in their first post-graduate year, who participated in a nationwide Web-based survey, completing a total of 17,003 monthly reports. A regression analysis was performed to determine the relationship between the number of extended duration work shifts (greater than or equal to 24 hours in length), reported medical errors and a self-reported measure of stress.

It was discovered that the reporting of medical errors and the number of extended duration shifts worked in a month were both significant predictors of stress. Compared to months in which no extended duration shifts were worked, interns working five or more extended duration shifts had seven times greater odds of reporting at least one fatigue-related significant medical error that resulted in an adverse patient event and reported 300 percent more fatigue-related preventable adverse events resulting in the death of the patient. Moreover, interns who reported a medical error that resulted in an adverse patient outcome were more than three times as likely to report high stress in that month.

“These results suggest that extended duration shifts negatively impact patient safety and the well-being of medical interns. They have important public policy implications for post-graduate medical education and suggest the need for counseling or other care for interns who make medical errors,” said Barger.

The amount of sleep a person gets affects his or her physical health, emotional well-being, mental abilities, productivity and performance. Recent studies associate lack of sleep with serious health problems such as an increased risk of depression, obesity, cardiovascular disease and diabetes.

Experts recommend that adults get between seven and eight hours of sleep each night to maintain good health and optimum performance.

Persons who think they might be suffering from a sleep disorder are encouraged to consult with their primary care physician, who will refer them to a sleep specialist.

The annual SLEEP meeting brings together an international body of 5,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.

More than 1,000 research abstracts were presented at the SLEEP meeting, a joint venture of the American Academy of Sleep Medicine and the Sleep Research Society. The four-day scientific meeting brings to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.

Source : www.medicalnewstoday.com

Doctors told to ’say it like it is’ when it comes to obese kids

A committee of medical experts say doctors need to stop looking for fuzzy terms to define children’s weight problems and should say it like it is.
The panel assembled by the American Medical Association, comprised of 15 medical organizations and funded by federal health officials, have come up with recommendations designed to be guidelines for pediatricians and other medical professionals who work with children.

They say when a child is obese, doctors should call him “obese” and not skirt the issue with terminology such as “overweight” or “at risk for overweight” as such categories do not define the problem.

The committee say doctors often avoid using blunt terms out of fear that they’re going to “stigmatize” children, or “take away their self esteem.”

The panel says the recommended terms do not mean that doctors should be insensitive or use the label in front of every patient.

Experts say about 17 percent of U.S. children are obese and one-third are overweight and the numbers are rising, putting children at risk for diabetes, high blood pressure, cholesterol problems and other ailments more commonly found in adults.

The change in terms is among several recommendations the committee is promoting to help doctors prevent, diagnose and treat obesity in children.

Other recommendations include assessing weight and body mass index at least yearly; and evaluating eating habits and activity levels on all visits to the doctor.

Source : www.news-medical.net

Diabetes easily identified in pregnant women with simple blood test

While assessing plasma blood glucose levels using the HbA1c test is not a very sensitive method for diagnosing gestational diabetes, those women with higher HbA1c levels when this type of diabetes is diagnosed are much more at risk of developing type 2 diabetes later. HbA1c is a measure of the amount of blood glucose attached to the haemoglobin of red blood cells.

Almost half of the South Asian and a quarter of the Caucasian women who experienced gestational diabetes developed type 2 diabetes within five years. But the risk of future diabetes was only 10 per cent in Caucasian women with HbA1c glucose tolerance. The authors said the findings highlight the need for proactive screening for diabetes in women with previous gestation diabetes mellitus. This is an impaired glucose tolerance first recognised during pregnancy, it affects around 5% of pregnant women.

The importance of early identification of diabetes is set out in standard 2 of the National Screening Framework for diabetes.

Source : www.news-medical.net

Parents May Play Role In Their Kids’ Migraine Headache Pain

According to preliminary results of an ongoing study at Columbus Children’s Hospital, to be presented at the American Headache Society’s June meeting in Chicago, parents of adolescents with migraines may have an influence on the level of pain reported.

Approximately 10 percent of children and adolescents get migraines, and as many as two percent suffer from chronic migraines, meaning 15 or more headaches a month. Nearly nine times out of 10, those kids come from families who have a history of migraines, and although the migraines may be shared, researchers aren’t convinced the pain is necessarily the same.

“We want to know how much of a child’s response to migraine pain is learned and how much is hereditary,” said lead author Ann Pakalnis, MD, a neurologist at Columbus Children’s and a faculty member of The Ohio State University College of Medicine.

The study examined the relationship between parental reports of their own disability due to chronic pain conditions and migraine related disability as reported by their adolescents. Researchers looked at twenty adolescents, ages 12 to 17 years, who averaged between one and 15 moderate to severe migraines each month, and their parents. Nearly 93 percent of parents in the sample reported having at least one chronic pain condition. Researchers found there was a significant correlation between the pain reported by parents and that reported by their children or teens.

Preliminary data from this ongoing study suggests those parents who report more disability due to chronic pain conditions rate their adolescents as being more disabled and have adolescents who report being more disabled by migraines. Parental disability was also positively correlated with adolescents’ reports of both number and severity of symptoms experienced.

“When talking with children individually, they tend to report less pain and disability,” said Pakalnis. “On the other hand, adults with a history of chronic pain tend to over-report their child’s perception of migraine pain as compared to parents or guardians that do not have a chronic pain problem.”

These results, if supported by further data collection and analysis, may have significant clinical implications for the assessment and treatment of migraines in the adolescent population. Inaccurate pain reporting could lead to unnecessary treatment or excessive medication.

“No one doubts these kids suffer from migraines,” says Dr. Pakalnis. “But if we can better understand their individual level of pain, we can develop individual treatments that are best for them.”

Since the level of pain tolerance varies from one person to the next, doctors say it’s important that parents don’t make assumptions about their child’s pain or speak for their child during doctors’ visits.

Source : www.medicalnewstoday.com

Low Libido In Menopause Linked To Trouble Sleeping

Women whose sexual desire diminishes during menopause are more likely to report disturbed sleep, depression symptoms, and night sweats, according to Group Health research in the June American Journal of Obstetrics and Gynecology.

To the best of the research team’s knowledge, this marks the first time that sleep disturbance has been independently associated with diminished sexual desire during or after menopause.

The paper is based on data from Group Health’s Herbal Alternatives for Treatment of Menopause Symptoms (HALT) study. Other results from this study, showing that the herbal supplement black cohosh did not relieve menopausal hot flashes or night sweats (hot flashes during sleep), were reported in the Annals of Internal Medicine in 2006.

All 341 of the women were chosen to be in the study because they were age 45 to 55 and had hot flashes, night sweats, or both. Of them, 64 percent reported diminished sexual desire, 43 percent slept poorly, and 18 percent had major depression.

“It seems reasonable that night sweats can disturb sleep,” said Susan D. Reed, MD, MPH, the paper’s lead author. Dr. Reed is an associate professor of obstetrics and gynecology and epidemiology at the University of Washington and an affiliate investigator at Group Health Center for Health Studies. “And poor sleep can reduce energy for everything, including sex.”

However, Dr. Reed cautioned against inferring cause and effect between depression and low libido. “They are each so complex that the interactions can be difficult to tease apart.”

Dr. Reed noted a well-established “catch 22″: Like depression itself, treating depression with a selective serotonin reuptake inhibitor (SSRI), the most common type of antidepressant medication, can interfere with interest in sex. Likewise, she added, although systemic hormone therapy with estrogen can reduce vaginal dryness, it can also lower women’s natural testosterone, which affects some women’s libido.

“Before starting any drug treatment for changes that happen in menopause, women need to weigh their individual risks and benefits with their doctors,” said Dr. Reed. She advocates beginning with self-care to lessen depression and sleep problems (see below). Previous studies have established that, for women, the most important factor for maintaining sexual desire is the quality of their intimate relationships. “Diminished desire can be a red flag that the relationship needs some work,” she said. “Middle age is a great time for couples to check in with each other and work toward improving communication and nurturing their partnership.”

With age, sexual desire may be diminished for both women and men, said Dr. Reed, whose clinical practice is at the Women’s Clinic at Harborview Medical Center in Seattle. But gender differences may complicate matters. “For women, greater intimacy tends to open the door to more sexual desire,” she said. “That’s not always true for men.”

“Our work reinforces the difficult time some women have during the menopause transition, and the importance of other symptoms happening at the same time,” said Katherine M. Newton, PhD, associate director of Group Health Center for Health Studies and principal investigator of the HALT study. “We are planning future studies to explore further the associations between depression, night sweats, sleep, and libido, including genetic determinants.”

The National Institute on Aging and the National Center for Complementary and Alternative Medicine funded the study. The other authors are Andrea LaCroix, PhD, Louis Grothaus, MS, and Kelly Ehrlich, MS, of Group Health Center for Health Studies.

About Group Health Center for Health Studies

Founded in 1947, Group Health is a Seattle-based, consumer-governed, nonprofit health care system that coordinates care and coverage. Group Health Center for Health Studies conducts research related to prevention, diagnosis, and treatment of major health problems. It is funded primarily through government and private research grants.

Self-care tips for menopause

Changes that happen with menopause can disturb women’s sense of well-being. But experts recommend a variety of steps that women can take on their own to feel better through the transition. Jane Ann Dimer, MD, a 44-year-old Group Health Women’s Health Service line chief, provided these self-care suggestions for the following menopause-linked symptoms:

Depression:

* Support ongoing regular physical exercise – whatever works for you (be it yoga or karate) – to promote fitness, balance, social networking, and an energetic approach to life.

* Eat small, balanced meals, including snacks, at regular intervals. Avoid getting too hungry or overeating, because a full stomach can make you feel glum.

* Try new activities.

* Spend some time every day outside in the daylight.

Low libido:

* Address the changes that menopause and age – including changes in male sexual response – can bring to relationships.

* Be aware that both women and men may need more time for arousal.

* Try learning to massage each other.

* Talk to your doctor about solutions for vaginal dryness, e.g., lubricants and topical estrogen.

Vaginal dryness:

* Talk to your doctor about applying small amounts of vaginal estrogen, e.g., through an estradiol vaginal ring (which is discrete and not messy and can have the secondary effect of raising interest in sex through novelty).

* Avoid unhealthy practices, e.g., douching and over-the-counter vaginal creams.

Night sweats:

* Sleep in a cool room. Near your bed, place ice water and a fan – or a spray bottle with plain or scented water.

* Avoid possible triggers such as very hot liquids and alcohol.

Disturbed sleep:

* Try taking a warm shower just before going to bed: The effect of cooling off may help you drift to sleep.

* Try wearing a sleep mask.

* Especially if you snore, are overweight, or have lung problems, talk to your doctor about the possibility that you might have undiagnosed sleep apnea.

* Some sleep disturbance results from tooth grinding. So ask your dentist whether you grind your teeth; if so, wearing a night guard might decrease your tooth grinding and help you sleep more soundly.

Source : www.medicalnewstoday.com

How and why weight-reducing surgery sometimes cures diabetes

Scientists at Swansea University’s School of Medicine have been awarded more than £93,000 by the BUPA Foundation to investigate why weight-reducing surgery can lead to the almost immediate disappearance of diabetes in patients.
95% of morbidly obese people – those with a Body Mass Index of over 40 – have Type 2 diabetes, sometimes known as maturity-onset diabetes.

However, nearly 80% of patients who undergo gastric bypass surgery to reduce the size of their stomachs and small intestines find that their diabetes disappears within two to three days – before any weight loss has occurred.

Senior Clinical Lecturer Dr Jeffrey Stephens is leading the research at the School of Medicine’s Diabetes Research Group. He said: “Although patients with Type 2 diabetes do not always require insulin treatment, the average diabetic needs about 30 units of insulin a day to control blood sugar levels.

“For obese patients, this can rise to 200 units a day. To go from such a high level of insulin-dependency to not needing insulin in a matter of a few days is a dramatic result, and we need to understand the reasons why this happens.”

The research team, which includes Professor Steve Bain and Professor Rhys Williams from Swansea University’s School of Medicine, and Professor John Baxter, a bariatric surgeon with Swansea NHS Trust, are focusing attention on a protein known as Glucagon Like Peptide 1 (GLP-1), which is produced in the small intestine.

Dr Stephens said: “Overweight people who have Type 2 diabetes tend to have lower levels of GLP1 and we are investigating whether these levels return to normal after bariatric surgery. Basically, we want to know whether reducing the size of the small intestine and stomach restores production of GLP1, and why this should be the case.”

High blood sugar seen with poorly controlled diabetes may cause lethargy, excessive thirst and susceptibility to infection, and contributes to diabetic complications including premature heart disease, stroke, blindness, and gangrene.

“Bariatric surgery is not just effective in terms of controlling obesity. It clearly has other major health implications, with the potential to impact positively on Type 2 diabetes and other associated conditions. There is also the potential for the NHS to generate substantial savings in long term treatment costs,” added Dr Stephens.

“Not only will this research improve our understanding of why overweight people develop Type 2 diabetes, it may also lead to an effective, non-surgical treatment for those with the condition. We are immensely grateful to the BUPA Foundation for giving us this opportunity.”

Source : www.swan.ac.uk

Low testosterone means men may die young

A new study suggests that men with low levels of testosterone are more likely to die young; they apparently have a 33% increased risk of death over an 18-year period than those with higher levels.
The researchers at the University of California’s San Diego School of Medicine, say such men are less likely to reach middle age compared with those who have high levels of the male sex hormone.

The study findings provide more evidence that there may be a case for some men being placed on “testosterone replacement therapy” – the male equivalent of hormone replacement therapy in women.

The decline in the levels of the hormone is called the andropause or male menopause.

The researchers said it was too early, however, to recommend that vulnerable men use testosterone patches.

The study’s lead author Dr. Elizabeth Barrett-Connor, says though the findings have very exciting and important implications, they are not advocating that men should take testosterone to prolong their lives.

Dr. Barrett-Connor suggests it is possible that lifestyle determines the level of a man’s testosterone and it may be that testosterone levels can be altered by lowering obesity.

Testosterone is a hormone produced in the testes; it triggers the onset of puberty and is closely associated with the libido.

Experts say testosterone levels vary widely from man to man and often fall with age and fatherhood.

Low testosterone levels have been associated with a lower sex drive, mood swings, weaker muscles and a greater risk of osteoporosis.

For the study the researchers examined the medical histories of 800 Californian men, aged 50 to 91, who were taking part in a chronic disease study started in the 1970s.

It was found at the start of the 1980s that a third of the men had unusually low testosterone levels for their age.

The difference could not be explained by smoking, drinking, physical activity or pre-existing illnesses such as heart disease and diabetes and this group of men had a 33 per cent greater risk of dying during the next 18 years than the men with high testosterone levels.

The researchers say why low testosterone is linked to premature death is unclear but men with the lowest levels were more likely to be obese, have high blood pressure and high levels of “bad” cholesterol.

Experts say levels of testosterone in men of all ages are falling and the study is of interest because of the association with metabolic syndrome, the risk factors for which include waist measurement over 102 cms, high levels of cholesterol, high blood pressure and high blood sugar.

They say the use of testosterone supplements is a contentious one because of the potential side effects.

The team presented their findings at the Endocrine Society conference in Toronto.

Source : www.news-medical.net

Statins: Safe, Well Tolerated, And Effective

Statins are safe, well tolerated, and have a proven impact on cardiovascular disease, concludes the author of a Review published early Online and in an upcoming edition of The Lancet.

Dr Jane Armitage, Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, UK, did a comprehensive Review of research published between 1985 and 2006 studying the safety, efficacy, and side effects of statins.

Given at standard daily doses (which vary between different types), statins typically reduce LDL cholesterol by 30-45% in the blood. Six statins are available in most parts of the world: lovastatin, simvastatin, pravastatin, fluvastatin, atorvastatin, and rosuvastatin.

Dr Armitage says: “Since statins were first approved in 1987, their ability to reduce the risks of vascular death, non-fatal myocardial infarction, stroke, and the need for arterial revascularisation has been shown by several large, high-quality randomised trials.”

The Review says that adverse effects from some statins on muscle, such as myopathy (pain/weakness) and rhabdomyolosis (breakdown of muscle) are rare at standard doses. Myopathy occurs in fewer than one in 10 000 patients at these standard doses. Adverse side effects on the liver, from increasing levels of transaminases associated with statin use, are also rare.

Also examined is the safety of statins in vulnerable groups, such as the elderly, patients who consume excess alcohol or are on warfarin. There is no evidence to suggest people consuming excess alcohol are at greater risk of side effects from statin use, however the Review warns that many such people were excluded from statin trials. Warfarin users may need to adjust the amounts of warfarin they take when statin treatment begins and again when it ends. Evidence suggests no adjustment of dosage is needed for the elderly, since people aged up to 80 years were recruited in the various trials. However the Review cautions that the very elderly may at increased risk of myopathy.

Dr Armitage concludes: “Statins are a well-tolerated and extensively studied group of drugs. Their proven impact on cardiovascular disease risk has been driving their widespread use.

“With a few caveats and while awaiting good quality randomised data for the newer drugs, statins seem to be a remarkably safe group of drugs when used at their usual doses.”

Source : www.medicalnewstoday.com