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Statins for delaying the onset and progression of age‐related macular degeneration

AMD is a progressive disease of the macula (area in the back of the eye affecting central vision). AMD is the leading cause of blindness in people over 65 years in industrialized countries. Studies have shown that some of the factors that may lead to heart disease and strokes are the same as those that may lead to AMD. Statins are a type of drug that aims to lower blood cholesterol levels. As statins are very effective in preventing strokes, it is possible that they are also protective for AMD.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Statins for acute ischemic stroke

Stroke is a major public health problem than can cause death and severe disability. A limited number of drugs are available for treating patients with stroke. Statins, a group of drugs commonly used to reduce cholesterol levels, are known to be safe and effective when given to patients with an acute heart attack. Therefore, they may also be beneficial in patients with acute stroke. We identified eight relevant trials of statins in acute stroke involving 625 participants. Unfortunately, insufficient information was available to establish whether statins are safe and beneficial for patients with acute ischemic stroke

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

The use of Statins, cholesterol lowering agents, in patients with multiple sclerosis (MS)

MS is an inflammatory demyelinating disease of the human central nervous system and it is thought to be related to abnormal working of the immune system. Preliminary studies have shown that statins, cholesterol lowering agents, have potential immunological regulation effects which may be beneficial for MS. Furthermore, statins are usually orally administered, are less expensive than other MS treatment, and are easily available.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Statins for the treatment of polycystic ovary syndrome

Women with polycystic ovary syndrome (PCOS) may suffer from irregular periods, excessive hair growth (hirsutism) and acne (pimples). High levels of serum androgens (male hormone) are one of the main features of PCOS. There is no good evidence from this review that statins improve menstrual regularity, spontaneous ovulation rate, hirsutism or acne, either alone or in combination with the combined oral contraceptive pill. There is also no good evidence that statins have a beneficial effect on hirsutism or acne (pimples) associated with PCOS. In women with PCOS, statins are effective in reducing serum androgen levels and decreasing bad cholesterol (LDL), but statins are not effective in reducing fasting insulin or insulin resistance. There is no good evidence available on the long‐term use of statins (alone or in combination) for the management of PCOS.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Statins for the prevention of dementia

Dementia (including Alzheimer's disease) is a global healthcare concern; the number of people affected worldwide is predicted to double every 20 years, reaching 74.7 million in 2010 and 131.5 million in 2050. Therefore, it is important to find means of preventing dementia. It has been suggested that high levels of cholesterol in the serum (part of the blood) may increase the risk of dementia and that treatment with cholesterol‐lowering medicines such as statins may reduce the risk of dementia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Statins for the treatment of Alzheimer's disease

High levels of cholesterol (a fatty substance known as a lipid) in the blood are thought to contribute to the cause of Alzheimer's disease and vascular dementia. The statin family of medications (lovastatin, pravastatin, simvastatin and others) are powerful cholesterol‐lowering medications and are first‐line treatments for reducing cholesterol in people with, or at risk of, cardiovascular disease. There has been much interest in the possible role of statins in the treatment of dementia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Comparing Statins and Combination Drugs

How do statins and combination drugs compare in lowering "bad" cholesterol (LDL-c)?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: November 1, 2010

Statins: How well do they prevent complications of coronary artery disease?

Statins have been proven to lower the risk of heart attack and stroke in people who have coronary artery disease, and to improve their life expectancy. Most people tolerate the drug fairly well.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 26, 2013

Coronary artery disease: Medication for long-term treatment of CAD

The most important part of long-term treatment for coronary artery disease (CAD) is taking medication. The different types of drugs aim to both reduce symptoms and prevent complications.Three main groups of drugs are used to help prevent complications of coronary artery disease (CAD), also known as coronary heart disease (CHD): antiplatelets, statins and beta blockers.In some cases, ACE inhibitors or angiotensin II antagonists (sartans) will also be used. Each of these groups of drugs has an effect on a different part of the disease, and that is why they are used in combination. Conclusive studies have proven that these drugs can lower the risk of complications such as heart attacks or strokes.Some people also take dietary supplements containing omega-3 fatty acids or vitamins. But research has shown that these products are not effective. Some vitamin supplements can even be harmful if taken in high doses.All drugs can have side effects. Yet it is often possible to avoid them by adjusting the dose or by choosing another drug from the same group. Also, the side effects will only last as long as the drugs are taken. Some may occur only at the start of the treatment.The risk of side effects can increase when two or more drugs are taken together, because they may interact. It is therefore important to tell your doctor what medication you are already taking. What is more, not every drug is suitable for everyone who has CAD. Whether or not a particular drug is suitable will depend on various factors, such as age or whether someone has other medical conditions besides CAD.Even the very best medical treatment will offer only limited protection from heart disease. A general rule of thumb is the more risk factors an individual has, the more likely it is that he or she will benefit from medication. The important thing is to continue to take your medication and to take it regularly – its protective effect lasts only as long as it is used.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 26, 2013

The effect of the timing of statin administration on hyperlipidaemia

Cardiovascular disease (CVD), which comprises heart attacks (myocardial infarction), angina, and strokes, is the principal cause of death in the world and is a major cause of morbidity worldwide. High blood cholesterol is linked to CVD events and is an important risk factor. Therefore, decreasing high blood cholesterol is an important way to reduce the chances of suffering a CVD event. Blood cholesterol may come from foods that are high in fat, and is also produced by some of our body’s organs (most of this production is at night (between 12:00 am and 6:00 am).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Fibrates for patients without established cardiovascular disease

Cardiovascular disease is the most common cause of death, illness, disability, and reduced quality of life in industrialised countries. One of the major risk factors for cardiovascular disease is elevated low‐density lipoprotein cholesterol (LDL‐C, 'bad' cholesterol). In addition, persons with elevated serum triglycerides and low levels of high‐density lipoprotein cholesterol (HDL‐C, 'good' cholesterol) are also at increased risk for cardiovascular disease events such as heart attacks or strokes. Fibrates lower serum triglycerides, modestly raise HDL‐C, and modestly lower LDL‐C. Therefore, long‐term therapy with fibrates may help prevent cardiovascular disease events, in particular in combination with statins, for which it has been shown that they substantially lower LDL‐C and reduce the risk of heart attack, stroke, and overall mortality.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Cholesterol‐reducing drugs for brain haemorrhage (subarachnoid haemorrhage)

Subarachnoid haemorrhage (SAH) is a serious condition where bleeding occurs over the surface of the brain. This bleeding usually comes from an abnormality (aneurysm) in one of the blood vessels on the brain surface. In addition to the damage caused by the initial bleeding, people with SAH often suffer a later reduction in blood flow to the brain and hence additional delayed brain injury. It has been proposed that cholesterol‐reducing drugs may reduce this delayed brain injury. This review found only one small trial of 39 participants. Cholesterol‐reducing drugs did not reduce the risk of delayed brain injury and did not significantly improve participants' degree of recovery. There were no significant differences in adverse events. This review is based on one small trial and no reliable conclusions can be drawn at present.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Statins for non‐alcoholic steatohepatitis

Non‐alcoholic fatty liver disease (NAFLD) and non‐alcoholic steatohepatitis (NASH) in patients with no or very little alcohol consumption is characterised by hepatic histological changes similar to those associated with alcohol‐induced liver injury. A range of histological changes can be seen. Some patients have fat accumulation in hepatocytes without significant inflammation or fibrosis (simple hepatic steatosis or NAFLD), but others have hepatic steatosis with prominent necro‐inflammatory changes with or without associated fibrosis (this is NASH). Although NAFLD and NASH are common conditions, no effective medical treatment is available to correct the abnormal liver enzymes and adverse outcomes associated with them. This systematic review identified two randomised clinical trials with very small numbers of participants. One of the trials was a pilot trial and compared simvastatin with placebo, and the other trial assessed atorvastatin versus fenofibrate versus a combination of the two. The small pilot trial (n = 16 patients) assessing simvastatin versus placebo in NASH patients did not show significant effects on liver enzyme activities or liver histology. No adverse events were reported. The other trial compared atorvastatin versus fenofibrate versus a group receiving both interventions in 186 patients with NAFLD. There were no statistically significant differences between any of the three intervention groups regarding the 54 week mean activities of aspartate aminotransferase, alanine aminotransferase, gamma‐glutamyl transpeptidase, or alkaline phosphatases (liver enzymes) in the blood. The triglyceride levels seemed higher in the fenofibrate group compared with the atorvastatin group. Liver histology was not assessed in this trial. The presence of biochemical and ultrasonographic evidence of NAFLD seemed higher in the fenofibrate group compared with the other two intervention groups. Three patients discontinued treatment due to myalgia and elevated serum creatine kinase activity, one from the atorvastatin group and two from the combination group. Another patient from the atorvastatin group discontinued treatment due to raised alanine aminotransferase activity, over three times the upper normal limit. Both trials were at high risk of bias (that is, overestimation of benefits and underestimation of harms). Furthermore, the groups were small raising the risks of random errors (that is, play of chance). Accordingly, we did not find evidence to support or refute the use of statins for patients with NAFLD or NASH. Further unbiased trials with larger numbers of patients looking explicitly at patient‐related outcomes of interest (for example, quality of life, development of cirrhosis, and mortality) are needed to assess the effects of statins on NAFLD or NASH.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Medications for cognitive decline in people with Down syndrome

People with Down syndrome often experience cognitive decline (a deterioration in memory, language, thinking and judgment that are greater than normal age‐related changes) at a younger age and in greater numbers than the general population. Various medicines have been shown to improve, or at least slow down the progression of these symptoms in people without Down syndrome.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Statins for acute coronary syndrome

Long‐term therapy with statins (for at least one year) has been shown to reduce the risk of heart attack, stroke, and all‐cause mortality in patients with and without established coronary heart disease. The early period following an acute coronary syndrome is a critical stage of coronary heart disease, with a high risk of recurrent events and death. We aimed to determine if early initiation of statins improves patient‐relevant outcomes within the first four months following an acute coronary syndrome. This review is an update of a review previously published in 2011 that included 18 studies, enrolling 14,303 patients. The update of this review did not identify any new studies for inclusion. We did not find a significant risk reduction for all‐cause mortality, heart attack, or stroke within the first four months. We had some concerns about risk of bias and imprecision of the results. The risk of unstable angina was reduced by about 25% at four months following acute coronary syndrome. Serious side effects from early treatment with statins were rare (0.1%), and serious muscle toxicity was mostly observed with simvastatin 80 mg.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Lipid‐lowering for peripheral arterial disease of the lower limb

Atheroma (fatty deposits) in the walls of the arteries to the legs can lead to peripheral arterial disease with insufficient blood flow to the muscles and other tissues. People with peripheral arterial disease often do not have symptoms. The most common symptom is intermittent claudication, which is characterised by leg pain and weakness brought on by walking, with disappearance of the symptoms following a brief rest. Lipid‐lowering therapies may reduce cardiovascular events and worsening of local disease for people with lower limb peripheral arterial disease. They are recommended to people with coronary artery disease, for prevention of myocardial infarction and stroke.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Lipid‐lowering agents for nephrotic syndrome

Nephrotic syndrome is a relatively rare disease in which the kidneys leak protein into the urine. A common early sign is swelling in the feet and face. Other signs and symptoms of nephrotic syndrome include low levels of protein in the blood, and high levels of fats in the blood, particularly cholesterol and triglycerides.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Interventions in the management of serum lipids for preventing stroke recurrence

There is evidence of a reduction in subsequent serious vascular events from statin therapy in patients with a history of ischaemic stroke or transient ischaemic attack (TIA). Studies have shown that interventions for reducing either total serum cholesterol or low density lipoprotein cholesterol levels reduce the risk of coronary heart disease (CHD) and stroke events in people with a history of CHD. However, for stroke patients the relation between the level of serum cholesterol and cholesterol subfractions with the risk of future stroke or cardiovascular events is unclear. This review, which includes eight studies involving approximately 10,000 participants, shows statin therapy, but not other lipid‐lowering measures, reduces the risk of subsequent major vascular events and a marginal benefit in decreasing stroke events, but not all‐cause mortality in those with a history of ischaemic cerebrovascular disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Medication for the treatment of high cholesterol levels

High cholesterol levels could mean an increased risk of cardiovascular disease. Certain medications that reduce cholesterol levels can prevent related health problems and increase life expectancy. Whether or not it is worth taking these medications will depend on what other risk factors you have.If the risk of cardiovascular disease cannot be reduced enough through general measures, treatment with medication can be considered. Whether or not it is worth taking medication will vary from person to person, depending on what other risk factors for cardiovascular disease they have and how important the advantages and disadvantages are to them.People’s individual approach to health will play a role too. If someone has unfavorable cholesterol levels but they do not have any other risk factors, or only a few, then they might prefer not to take medication. People who have several other risk factors might be more concerned so they might be more willing to take medication.When deciding whether or not to have a certain treatment, it can help to know what advantages and disadvantages the treatment has. Various groups of drugs can reduce cholesterol levels. But only one group of drugs, known as statins, has been well studied for the treatment of people who have never had a heart attack, stroke or other type of cardiovascular disease. Statins lower the risk of vascular disease by about 20% in these people. The health impact of this risk reduction will vary from person to person, though, mostly depending on their individual risk of cardiovascular disease. A doctor can help you determine your personal risk.Already having cardiovascular problems such as coronary artery disease is one major factor. If that is the case, it greatly increases the risk of heart attack or stroke. Medication can be used to reduce this risk very effectively.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: August 29, 2013

Statins for children with inherited high blood cholesterol

Familial hypercholesterolemia is an inherited disease in which blood cholesterol level is high. Vascular diseases often occur at an earlier age than usual, especially amongst men. Thus lifelong therapies to reduce blood cholesterol (started in childhood) are needed. In children with familial hypercholesterolemia, diet has been the main treatment option. Resins, such as cholestyramine and colestipol, have also been used effectively to lower low‐density lipoprotein (LDL) cholesterol. However, these usually taste unpleasant and are poorly tolerated; so they are poorly adhered to. Since the 1990s statin trials have been carried out among children and adolescents with familial hypercholesterolemia. Statins have decreased their serum LDL cholesterol levels by about one third in these studies. Additionally, in one study, statins improved the arterial function and in another study they reduced the thickness of the already thickened neck artery. Even though statins seem to be safe and well‐tolerated in children, their long‐term safety in this age group is not firmly established.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

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