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AFD - Statins Revisited

sharon sanders

Editor-in-Chief & President
Statins Revisited



# 3911


The question as to whether statins ? commonly used cholesterol lowering drugs ? might play a positive role in the treatment of influenza and pneumonia is one that we?ve discussed numerous times over the years.

We?ve seen a see-sawing of opinion, driven by a parade of conflicting studies. Today we?ve new research to look at, but first a review of the recent past.
Dr. David Fedson was probably the first to champion the idea of using statins for an influenza pandemic. In his paper on the subject, published in July of 2006.

Pandemic Influenza: A Potential Role for Statins in Treatment and Prophylaxis<sup> </sup>
David S. Fedson<sup>a</sup>

The next<sup> </sup>influenza pandemic may be<sup> </sup>imminent. Because antiviral agents<sup> </sup>and vaccines will be<sup> </sup>unavailable to people in<sup> </sup>most countries, we need<sup> </sup>to determine whether other<sup> </sup>agents could offer clinical<sup> </sup>benefits. Influenza is associated<sup> </sup>with an increase in<sup> </sup>acute cardiovascular diseases, and<sup> </sup>influenza viruses induce proinflammatory<sup> </sup>cytokines.

Statins are cardioprotective<sup> </sup>and have anti-inflammatory and<sup> </sup>immunomodulatory effects, and they<sup> </sup>thus might benefit patients<sup> </sup>with influenza.

In 2007 we saw a study that seemed to support the idea, that indicated that statins lowered the mortality rate of people with pneumonia.

Statin drugs lower respiratory death risk: study
Tue Apr 10, 2007 12:40pm EDT
By Maggie Fox, Health and Science Editor
WASHINGTON (Reuters) - People who use statin drugs are less likely to die of influenza and chronic bronchitis, according to a study that shows yet another unexpected benefit of the cholesterol-lowering medications.

Their study of more than 76,000 people showed that those who had taken statins for at least 90 days had a much lower risk of dying from chronic obstructive pulmonary disease or COPD, the technical name for emphysema and chronic bronchitis.
Dr Fedson and Peter Dunnill, DSc,FREng then collaborated on a commentary, published in the Permanente Journal, Summer 2007 edition, on how we might confront an imminent pandemic.

The commentary was called New Approaches to Confronting an Imminent Influenza Pandemic, and in it the authors presented options including two possible routes to producing vaccine in quantity, and the use of statins to mitigate the effects of a cytokine storm.

(More on Dr. Fedson at the bottom of this blog)
In January of 2008, Australian researchers announced encouraging results from studies conducted on mice given gemfibrozil, a fibrate, which is another class of cholesterol lowering drug.

And just a year ago, in October of 2008, we learned:

Statins may cut pneumonia death, blood clot risks
27 Oct 2008 20:00:13 GMT
Source: Reuters
By Will Dunham
WASHINGTON, Oct 27 (Reuters) - Cholesterol-fighting drugs known as statins reduced the risk of dying from pneumonia or developing dangerous blood clots in the legs, adding to a growing list of benefits from the popular drugs, two research groups said on Monday.

Statins, the world's top-selling drugs, cut heart attack and stroke risk, and research has suggested other benefits including possibly protecting against Alzheimer's disease.

Of course, not all of the news was positive.

Just last July we heard that there were no signs of benefit among pneumonia patients (see Another Take On Statins And Pneumonia), where I reported on this story:

Statins don't lower risk of pneumonia in elderly

British Medical Journal study includes 3,000 Group Health patients

SEATTLE? Taking popular cholesterol-lowering statin drugs, such as Lipitor? (atorvastatin), does not lower the risk of pneumonia. That's the new finding from a study of more than 3,000 Group Health patients published online on June 16 in advance of the British Medical Journal's June 20 print issue.

"Prior research based on automated claims data had raised some hope?and maybe some hype?for statins as a way to prevent and treat infections including pneumonia," said Sascha Dublin, MD, PhD, a physician at Group Health and assistant investigator at Group Health Center for Health Studies. "But when we used medical records to get more detailed information about patients, our findings didn't support that approach."
Conflicting medical studies are nothing new. We see them all the time. Science is often messy and we get to the truth by fits and starts ? and that can sometimes take years.

Today we?ve news of new research on statins, presented at the annual meeting of the IDSA, the Infectious Diseases Society of America, in Philadelphia.

Maryn McKenna writing for CIDRAP brings us the details.

Statins may help patients with severe seasonal flu

Maryn McKenna
purple-speck.gif
Contributing Writer

Oct 29, 2009 (CIDRAP News) ? Commonly available drugs that are sold in lower-cost generic versions improve the survival of patients hospitalized for seasonal influenza, researchers reported today, raising the possibility of a widely available treatment that could be used in a severe flu pandemic if other drugs are in short supply.

The research, by the US Centers for Disease Control and Prevention (CDC) and scientists in several states, is part of a slate of new flu reports being presented this weekend at the annual meeting of the Infectious Diseases Society of America (IDSA) in Philadelphia. Also on the agenda: findings that flu vaccination of pregnant women has a protective effect on their babies both before and after birth, and news of what may be the first person-to-person transmission in the United States of H1N1 flu strains resistant to antiviral drugs.

The research presented Thursday examined the effect of the cholesterol-lowering drugs called statins on the clinical course of people who were already taking the drugs and then were hospitalized with lab-confirmed flu infections in the 2007-08 flu season. Those who were already on statins were half as likely to die, Meredith Vandermeer of the Oregon Public Health Division said during a press briefing at the state of the meeting.

The patients were identified via surveillance in 10 states conducted by the CDC?s Emerging Infections Programs; data on their lab results, prescriptions and outcome were drawn from reviews of their medical records. There were 2,800 lab-confirmed cases of flu in the surveillance results, Vandermeer said; 801 of those patients were recorded as taking statins during their hospital stay, presumably because they had been prescribed them before admission. Among the 2,800, 17 people who were on statins died, versus 64 were not on statins. Proportionally, that is 2.1% of those on statins and 3.2% of those not taking the drugs?a risk reduction of approximately half, Vandermeer said.

(Continue . . .)
Maryn?s article has additional details, plus reports on vaccine benefits in pregnant women, and the transmission of resistant H1N1 at a summer camp. Follow the link to read it in it?s entirety.

While not conclusive, this latest study offers some additional tantalizing evidence that statins might someday play a role in the treatment of influenza and pneumonia.

Further studies and controlled trials are needed, of course, before we can know for sure.

* * * * * * * * * * *

Dr. David Fedson, will be interviewed again on Radio Sandy Springs by Sharon Sanders of Flutrackers, at 4pm on Monday, Nov 2nd. You can listen online, or download the archived show later in the week.

Sharon interviewed Dr. Fedson last may, and you can listen to that archived show at 05/18/09 Guest Dr. David Fedson.
 
Re: AFD - Statins Revisited

It'd be interesting to know an estimate of how many people in the US are taking statins to treat high cholesterol and what the age range is. While it seems impossible, it would be helpful to know what percentage of the h1n1 fatalities (obviously minus the pediatrics) had been taking meds for high cholesterol...I wonder if we would find this to be a low number?
I've heard a few theories that statins work because they dramatically raise Vitamin D levels...ever come across any studies on that?
Thanks for revisiting this important topic. :)
In case anyone missed it, EM has a great post on this as well: http://scienceblogs.com/effectmeasure/2009/10/statins_for_influenza_why_dont.php#more
 
Re: AFD - Statins Revisited

Do statins raise vitD levels ? My husband is on a high dose of statins plus I put him on 3000iu of vitD a day ...Am I killing him ??:confused:
 
Re: AFD - Statins Revisited

Do statins raise vitD levels ? My husband is on a high dose of statins plus I put him on 3000iu of vitD a day ...Am I killing him ??:confused:

You know how it is, for every one discovery, another can be found to rebute it...here are some for and some against and most call for more testing. Grain of salt...:)
http://members.ift.org/NR/rdonlyres/E0E96507-C686-4BAC-ABE0-6FA85B5CAA0F/0/0909fmh.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2075568/
http://www.ncbi.nlm.nih.gov/pubmed/17398180
 
Re: AFD - Statins Revisited

I begin to appreciate the meaning of "ignorance is bliss " :D TY !
 
Re: AFD - Statins Revisited

I am taking Lipitor, for 3 years now, and caught the H1N1 during the Southern winter in June. I continued to take the simvastatin and my blood pressure med and beta blocker, though I discontinued the low dose aspirin for a week. I also pumped the Vitamin C, drank lots of fluids, juices, water, green teas, and made soups and lots of green veggies out of the garden. I had a mild fever and pretty bad cough and some nausea, but the only bad side effect I had was feeling weak and light-headed when I'd stand up. After a week I was sure I'd beaten it.
My younger brother in Texas had high blood pressure he'd not treated (he didn't like the side effects)with the medicine his doctor prescribed, and was never prescribed statins for his high cholesterol. He died in early September, so suddenly, just 3 days after we'd chatted by phone for hours and he'd complained of feeling exhausted and I'd warned him about the 'swine flu'. He had had his gall bladder removed 18 months earlier. He seldom took vitamin supplements and ate lots of fast foods, and when he got sick he didn't go to the doctor nor to the hospital in time (even though he had medical insurance he was anxious that they'd raise his rates if he used his coverage too often), and he keeled over and was found dead at home by his partner. His body wasn't tested for the H1N1 before cremation, but this flu took away my beautiful, my beloved brother I'm as sure of now as the day he died.

So whereas this is all very circumstantial, and there's other factors involved, I feel quite strongly that statins and anti-oxidants and Vit. D/D2 are safe when taken at recommended dosage and offer additional arsenal for H1N1 treatment...as supplements to the Tamiflu or Relenza or peramvir as a primary antiviral therapy. But I'm keeping an open mind on this. Statins may be contraindicated for pregnant women and those with liver diseases.
Ask your doctor first however, and if not satisfied with his/her response, then get a second opinion.

Sciene Daily recently had a story about safe levels of Vit. D ...here's it's repro of the BUSM study.

http://www.sciencedaily.com/releases/2009/10/091026161850.htm

ScienceDaily (Oct. 28, 2009) — Boston University School of Medicine researchers (BUSM) have found that 50,000 International Units (IU) of vitamin D2, given weekly for eight weeks, effectively treats vitamin D deficiency. Vitamin D2 is a mainstay for the prevention and treatment of vitamin D deficiency in children and adults. Continued treatment with the same dose of vitamin D2 every other week for up to six years after the initial eight-week period prevents vitamin D deficiency from recurring with no toxicity.

The BUSM study appears online in the journal Archives of Internal Medicine.

Vitamin D is essential for strong bones because it helps the body absorb calcium and phosphorus from the food we eat. Vitamin D deficiency can lead to rickets in children and the painful bone disease osteomalacia in adults. Vitamin D deficiency can also cause osteoporosis and has been linked to increased risk of cancer, heart disease, diabetes, autoimmune diseases and infectious diseases including influenza, according to senior author Michael F. Holick, PhD, MD, director of the Bone Healthcare Clinic and the Vitamin D, Skin and Bone Research Laboratory at Boston University School of Medicine.

Of the 86 patients researchers studied, 41 patients who were vitamin D deficient received eight weeks of 50,000 IU of vitamin D2 weekly prior to starting maintenance therapy. For those patients, the mean pre-treatment 25-hydroxyvitamin D status (25(OH)D) level was 19 ng/ml, which increased to 37 ng/ml after eight weeks of weekly therapy. These patients were then treated with 50,000 IU of vitamin D2 every other week and had a mean final 25(OH)D level of 47 ng/ml.
For the 45 patients who received only maintenance therapy of 50,000 IU of vitamin D2 every two weeks, the mean pre-treatment 25(OH)D level was 27 ng/ml and the mean final level was 47 ng/ml.

"Vitamin D2 is effective in raising 25(OH)D levels when given in physiologic and pharmacologic doses and is a simple method to treat and prevent vitamin D deficiency," said Holick, who is also director of the General Clinical Research Unit and professor of medicine, physiology and biophysics at BUSM. "While treating and preventing vitamin D deficiency, these large doses of vitamin D2 do not lead to vitamin D toxicity."

According to Holick, this is the first study demonstrating the efficacy of a prescription therapy to prevent vitamin D deficiency longterm in routine clinical practice
.

Quest Diagnostics, the nation's leading provider of diagnostics testing, information and services, analyzed the specimens used in the study.


--------------------------------------------------------------------------------

Adapted from materials provided by Boston University Medical Center, via EurekAlert!, a service of AAAS
 
Last edited:
Re: AFD - Statins Revisited

Thank you Florida1, Sally, Kiwibird and AlaskaDenise for your condolences on the death of my brother. I was so lucky to have John Darrell for a brother, and miss him each and every day, but he's at peace now and I'll do whatever I can to limit the number of others who might face this grim new situation and losing loved ones.
 
Re: AFD - Statins Revisited

Roehl_JC, I am sorry for your loss of your beloved brother. Thank you for your continued service to help others.
 
Re: AFD - Statins Revisited

Vanderbilt University Medical Center researchers are studying statins, the class of drugs long associated with lowering cholesterol, as a way to reduce H1N1-related deaths.

Gordon Bernard, M.D., associate vice-chancellor for Research at Vanderbilt and a critical care pulmonologist, believes statins may reduce flu-related deaths in the intensive care unit by as much as half.

?We know from studying infections that it's not always the bacteria that will kill you, but your own reaction to the bacteria can deal a lethal blow. We're learning that statins have an impact on the immune system and can dampen down that deleterious component of the immune response,? Bernard said.

?Statins are extraordinarily efficient at lowering cholesterol by 30 percent to 50 percent. This was a breakthrough for managing high cholesterol. Like so many drugs, including aspirin, it has many additional potential benefits, which were initially unrecognized.?
Bernard hopes to enroll patients in Vanderbilt's intensive care units (ICUs) who present with suspected H1N1 infection, and randomize them into two groups. One group will receive the statin rosuvastatin (Crestor, manufactured by AstraZeneca) every day for the duration of their hospital stay, and the other group will receive a placebo.

?Once a person with suspected H1N1 reaches the ICU, their mortality can be 20 percent or higher. Statins offer the potential to reduce it to 10 percent. Statins, if effective, could also reduce the patient's time on a mechanical ventilator in half from a current average of 14 days,? Bernard said.Bernard chose Crestor because of its favorable efficacy and safety profile.

"The statins, in general, are incredibly safe. Crestor effectively lowers LDL-C and has a safety profile that is in line with other marketed statins. Safety will be closely monitored in these studies but is not expected to be a significant issue,? Bernard said.

The study is just getting started at Vanderbilt. Both adults and children 13 and older, with suspected or confirmed influenza who are admitted to the ICU due to respiratory distress, are eligible. Some exclusions apply. Bernard hopes to extend the study to 100 other medical centers in order to capture 2,240 patients before the end of the epidemic. In order to do so, the study needs $3 million to $4 million in funding.

?We decided in August we had a problem that needed to be studied in the next several months and that for the trial to be ready to enroll patients from the current epidemic, it had to begin in early fall,? Bernard said. ?There is no funding mechanism at the National Institutes of Health, or anywhere else I know of, that could act that fast.

?We have a project that needs funding on an emergency basis. If it's not funded now, it will never get done in our lifetime. This trial provides a unique opportunity to identify the first-ever treatment for influenza other than antivirals, which are clearly not enough.?

http://www.mc.vanderbilt.edu/news/releases.php?release=1346
 
Re: AFD - Statins Revisited

Nov. 13, 2009 (United Press International) -- U.S. researchers are studying statins, drugs that lower cholesterol, as a way to reduce H1N1 virus-related deaths.
Dr. Gordon Bernard, a critical care pulmonologist, said the statins may reduce flu-related deaths in the intensive care unit by as much as half.

"We know from studying infections that it's not always the bacteria that will kill you, but your own reaction to the bacteria can deal a lethal blow. We're learning that statins have an impact on the immune system and can dampen down that deleterious component of the immune response," Bernard said in a statement.

"Statins are extraordinarily efficient at lowering cholesterol by 30 percent to 50 percent. Like so many drugs, including aspirin, it has many additional potential benefits, which were initially unrecognized."

Bernard said he hopes to enroll patients in Vanderbilt's intensive care units, who present with suspected H1N1 infection and randomize them into two groups. One group will receive the statin rosuvastatin, Crestor, every day for the duration of their hospital stay, and the other group will receive a placebo.

"Once a person with suspected H1N1 reaches the intensive care unit, their mortality can be 20 percent or higher, statins offer the potential to reduce it to 10 percent," Bernard said.


(Source: UPI )

http://www.istockanalyst.com/article/viewiStockNews/articleid/3634149
 
Re: AFD - Statins Revisited

Wed Dec 16 2009

Statins tested to treat H1N1 lung distress

SAN ANTONIO, Dec. 16 (UPI) --

Researchers at the University of Texas Health Science Center at San Antonio are studying treating H1N1 caused acute respiratory distress syndrome with statins.

"We are studying patients with H1N1 who are in their 20s and 30s and become severely sick, even to the point of having lungs that are white with inflammation," lead investigator Dr. Antonio Anzueto, a pulmonologist and professor in the Health Science Center School of Medicine, said in a statement. "Susceptible individuals include women in the last trimester of pregnancy, and men and women with underlying conditions such as asthma, obesity, diabetes and heart disease."

Statin drugs are approved for lowering cholesterol for heart disease but are not currently used for acute respiratory distress syndrome. However, there is scientific evidence they can decrease the severe respiratory swelling seen in patients with the disease.
Anzueto said H1N1 is a very lethal disease and patients require very aggressive therapy.

"Statin therapy is something we can do above and beyond what we are doing now," Anzueto said.

http://www.timesoftheinternet.com/138433.html
 
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