Dr. Ron’s Research Review – September 24, 2014

© 2014

This week’s research review focuses on Vascular Calcification and Lifestyle.

Statins

A meta-analyses of 22 trials showed that statin treatment was positively associated with a lowered risk of CVD with an odds ratio of about 0.79 for the total population and those with or without diabetes. (Chang et al., 2013)

Lifestyle

US participants who were 44-84 years of age (n = 6,229) were followed in the Multi-Ethnic Study of Atherosclerosis from 2000 to 2010. The following shows lower all-cause mortality over 7.6 years based on lifestyle score. The lifestyle score was defined by a binary score (Mediterranean- style diet vs. unhealthy diet, optimal BMI vs. suboptimal BMI, never smoker vs. ever smoker, and regular physical activity vs. sedentary lifestyle), with a score of 1 awarded for each healthy behavior. (Ahmed et al., 2013)

Score

Slower

95% CI

HR

95% CI

1

3.5

0.0, 7.0

0.79

0.61, 1.03

2

4.2

0.6, 7.9

0.61

0.46, 0.81

3

6.8

2.0, 11.5

0.49

0.32, 0.75

4

11.1

2.2, 20.1

0.19

0.05, 0.75

Notice that the lowest lifestyle score (1) had a hazard ratio (0.79) similar to that of statins (0.79) as reported in the meta-analysis by Chang!

Dr. Ron


 

Articles

Low-risk lifestyle, coronary calcium, cardiovascular events, and mortality: results from MESA.
(Ahmed et al., 2013) Download
Unhealthy lifestyle habits are a major contributor to coronary artery disease. The purpose of the present study was to investigate the associations of smoking, weight maintenance, physical activity, and diet with coronary calcium, cardiovascular events, and mortality. US participants who were 44-84 years of age (n = 6,229) were followed in the Multi-Ethnic Study of Atherosclerosis from 2000 to 2010. A lifestyle score ranging from 0 to 4 was created using diet, exercise, body mass index, and smoking status. Coronary calcium was measured at baseline and a mean of 3.1 (standard deviation, 1.3) years later to assess calcium progression. Participants who experienced coronary events or died were followed for a median of 7.6 (standard deviation, 1.5) years. Participants with lifestyle scores of 1, 2, 3, and 4 were found to have mean adjusted annual calcium progressions that were 3.5 (95% confidence interval (CI): 0.0, 7.0), 4.2 (95% CI: 0.6, 7.9), 6.8 (95% CI: 2.0, 11.5), and 11.1 (95% CI: 2.2, 20.1) points per year slower, respectively, relative to the reference group (P = 0.003). Unadjusted hazard ratios for death by lifestyle score were as follows: for a score of 1, the hazard ratio was 0.79 (95% CI: 0.61, 1.03); for a score of 2, the hazard ratio was 0.61 (95% CI: 0.46, 0.81); for a score of 3, the hazard ratio was 0.49 (95% CI: 0.32, 0.75); and for a score of 4, the hazard ratio was 0.19 (95% CI: 0.05, 0.75) (P < 0.001 by log-rank test). In conclusion, a combination of regular exercise, healthy diet, smoking avoidance, and weight maintenance was associated with lower coronary calcium incidence, slower calcium progression, and lower all-cause mortality over 7.6 years.

Reassessing the benefits of statins in the prevention of cardiovascular disease in diabetic patients--a systematic review and meta-analysis.
(Chang et al., 2013) Download
OBJECTIVES: Despite the fact that statins have been prescribed widely, cardiovascular disease (CVD) remains the leading cause of death in diabetic patients. The aim of this study was to reassess the benefits of statins for CVD prevention in patients with diabetes mellitus. METHODS: Two independent investigators searched for prospective, randomized statin trials that investigated the power of reducing CVD in statin-treated patients. The search was performed using Pubmed, Web of Science, and CENTRAL databases. Data was extracted from eligible studies. RESULTS: A total of 7061 articles were surveyed and 22 articles were identified as eligible articles. The meta-analyses of the 22 trials showed that statin treatment was positively associated with a lowered risk of CVD in the following groups: (i) total population with pooled odds ratios (OR) of 0.791 (95 % CI: 0.74-0.846, p < 0.001), (ii) diabetic population with OR 0.792 (95% CI: 0.721-0.872, p < 0.001), and (iii) non-diabetic population with OR 0.791 (95% CI: 0.730-0.857, p < 0.001). In diabetic patients, statins were also helpful in the primary and secondary prevention of CVD, with pooled ORs of 0.757 (95% CI: 0.676 to 0.847, p < 0.001) and 0.800 (95% CI: 0.712 to 0.898, p < 0.001), respectively. However, when trials that investigated only diabetic patients (i.e., CARDS, 4D, and ASPEN) were included in the analysis, statin treatment was not found to reduce CVD significantly (OR: 0.817, 95% CI: 0.649 to 1.029, p = 0.086). Furthermore, after performing subgroup analysis, no benefit of statin treatment was found in primary prevention (OR: 0.774, 95% CI: 0.506 to 1.186, p = 0.240) or secondary prevention (OR: 0.893, 95% CI: 0.734 to 1.088, p = 0.262) of CVD in diabetic patients. CONCLUSIONS: Although our study may be limited by unmeasured confounders and heterogeneity among the studies included, the results suggest that the effects of statins in the prevention of CVD in diabetic patients are not only beneficial. More informative data are needed to verify the benefits of statins in the protection against CVD in diabetic patients.

 

 

References

Ahmed, HM, et al. (2013), ‘Low-risk lifestyle, coronary calcium, cardiovascular events, and mortality: results from MESA.’, Am J Epidemiol, 178 (1), 12-21. PubMedID: 23733562
Chang, YH, et al. (2013), ‘Reassessing the benefits of statins in the prevention of cardiovascular disease in diabetic patients--a systematic review and meta-analysis.’, Rev Diabet Stud, 10 (2-3), 157-70. PubMedID: 24380090