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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 6, November/December 2017
AFRICA
407
overshadow the shortcomings. First, this was a single-centre
study with a limited number of participants. Second, heart
disease and especially heart failure in this population may have
included cases of different severity and chronicity, especially
ischaemic causes, which could limit the generalisability of their
findings to all hypertensive patients. Finally, further research is
required to determine the optimal cut-off points for diagnosis, the
relevance of serial measurements, changes following treatment,
and the prognostic role in Africans, before they can be widely
recommended for clinical decision making.
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Ojji DB, Opie, LH, Lecour S, Lacerda L, Adeyemi OM, Sliwa K. The
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Statins associated with improved heart structure and function
Statins are associated with improved heart structure and
function, according to
research presented recently at
EuroCMR 2017. The benefits were above and beyond the
cholesterol-lowering effect of statins.
‘Statins are primarily used to lower cholesterol’, said lead
author Dr Nay Aung, a cardiologist and Wellcome Trust
research fellow, William Harvey Research Institute, Queen
Mary University of London, UK. ‘They are highly effective
in preventing cardiovascular events in patients who have had
a heart attack or are at risk of heart disease.’
Hecontinued:‘Statinshaveotherbeneficial,non-cholesterol-
lowering, effects. They can improve the function of the blood
vessels, reduce inflammation, and stabilise fatty plaques in the
blood vessels. Studies in mice and small studies in humans
have shown that statins also reduce the thickness of heart
muscle but this needed to be confirmed in a larger study.’
This study investigated the association between statins
and heart structure and function. The study included 4 622
people without cardiovascular disease from the UK Biobank,
a large community-based cohort study. Cardiac magnetic
resonance imaging was used to measure left and right
ventricular volumes and left ventricular mass. Information
on statin use was obtained from medical records and a self-
reporting questionnaire.
The relationship between statin use and heart structure
and function was assessed using a statistical technique called
multiple regression, which adjusts for potential confounders
that can have an effect on the heart, such as ethnicity, gender,
age, and body mass index (BMI).
Nearly 17% of participants were taking statins. Those
taking statins were older, had higher BMI and blood pressure,
and were more likely to have diabetes and hypertension. ‘This
was not surprising because we prescribe statins to patients
at high risk of heart disease and these are all known risk
factors’, said Dr Aung.
Patients taking statins had a 2.4% lower left ventricular
mass and lower left and right ventricular volumes. Dr Aung
said: ‘People using statins were less likely to have a thickened
heart muscle (left ventricular hypertrophy) and less likely to
have a large heart chamber. Having a thick, large heart is a
strong predictor of future heart attack, heart failure or stroke
and taking statins appears to reverse the negative changes in the
heart which, in turn, could lower the risk of adverse outcomes.’
‘It is important to note that in our study, the people taking
statins were at higher risk of having heart problems than those
not using statins yet they still had positive heart remodelling
compared to the healthier control group’, added Dr Aung.
In terms of how statins might reduce the thickness and
volume of the heart, Dr Aung said several studies have
demonstrated that statins reduce oxidative stress and dampen
the production of growth factors that stimulate cell growth.
Statins also increase the production of nitric oxide by the
cells lining the blood vessels, leading to vasodilatation,
improved blood flow, lower blood pressure, and lower stress
on the heart, which is less likely to become hypertrophied.
The findings raise the issue of extending statinprescriptions
to anyone above the age of 40 years, but Dr Aung said that
was probably not the way to go.
‘There are clear guidelines on who should receive statins’,
he said. ‘There is debate about whether we should lower the
bar and the question is when do you stop. What we found is
that for patients already taking statins, there are beneficial
effects beyond cholesterol lowering and that’s a good thing.
But instead of a blanket prescription, we need to identify
people most likely to benefit, that is, personalised medicine.’
Dr Aung said: ‘A dual approach should be considered
to identify people who will benefit most from statins.
That means looking at not only clinical risk factors, such
as smoking and high blood pressure, but also genetic
(hereditary) factors, which can predict individuals’ response
to statins. This is an area of growing interest and one that we
are also investigating in our lab with our collaborators.’
Source
: European Society of Cardiology Press Office