heart attack

Statin dosage does not seem to affect recurrence.

* THE QUESTION It's clear that high doses of statins will lower cholesterol and help prevent heart disease. But once someone has had a heart attack, will more aggressive drug treatment decrease the likelihood of a repeat attack or other serious heart problems?

* THIS STUDY randomly assigned 8,888 people, mostly men, who'd had a heart attack to take a high dose of atorvastatin (Lipitor, 80 milligrams) or a regular dose of simvastatin (Zocor, 20 mg) daily. About half of the participants had been taking Zocor before the study began. During the treatment period, low-density lipoprotein cholesterol levels averaged 104 mg/deciliter for the Zocor group and 81 mg/dL for those taking Lipitor. After five years, there was little difference between the groups in the number of heart attacks and deaths from heart problems: They occurred in 10 percent of the people taking Zocor and 9 percent of those taking Lipitor. The risk of developing cancer or dying from anything other than a heart problem also did not differ between the groups. More people taking Lipitor had trouble tolerating the drug and quit the study.

* WHO MAY BE AFFECTED BY THESE FINDINGS? People who have had a heart attack.

* CAVEATS The study did not directly compare the two brand-name drugs because different dosages of each drug were used. Pfizer, which makes Lipitor, funded the study, monitored data collection and analyzed the data. Four of the 11 primary authors had received consultant's fees from the company, three others were its employees and one was a previous employee.

* FIND THIS STUDY Nov. 16 issue of the Journal of the American Medical Association; abstract available online at www.jama.com.

* LEARN MORE ABOUT statins at http://nhlbisupport.com and http://familydoctor.org.


Physical activity may reduce risk for black women, too.

* THE QUESTION Regular physical activity has been shown to help prevent breast cancer, but nearly all women studied have been white. Might black women expect the same benefit?

* THIS STUDY involved 4,538 women, 35 to 64 years old, with breast cancer, matched by age and race with 4,649 women without cancer. About 35 percent of both groups were black. Based on recreational exercise (including 400 activities, with walking, aerobics and bicycling the most popular) in which they participated from age 10 on, the risk of breast cancer decreased as the amount of physical activity increased. Women -- black or white -- who exercised at least 1 hour and 20 minutes a week, on average, were 20 percent less likely to have breast cancer than their inactive peers. The benefit did not apply to women whose family history made them more likely to develop the cancer.

* WHO MAY BE AFFECTED BY THESE FINDINGS? Women, black or white. One in eight women (13 percent) is likely to develop breast cancer at some point. Black women are slightly less likely to develop the cancer but more likely to die from it than white women.

* CAVEATS The study did not determine an age or time period when exercise might be most advantageous, nor did it identify specific activities or exercise intensity that conferred the most benefit. The findings may have been affected by the women's accuracy in recalling their participation in physical activity.

* FIND THIS STUDY November 16 issue of the Journal of the National Cancer Institute; abstract available online at http://jncicancerspectrum.oxfordjournals.org.

* LEARN MORE ABOUT breast cancer at www.cancer.org and www.y-me.org.


Lowering cholesterol may slow progression.

* THE QUESTION Laboratory research indicates that cholesterol plays a role in the development of the waxy deposits, or plaques, that clump together in the brain and characterize Alzheimer's. Leaping from the petri dish to the body, might lowering cholesterol through medication affect the development of the disease?

* THIS STUDY monitored the progression of dementia in 342 people diagnosed with Alzheimer's disease. About 68 percent of them had high cholesterol, and more than half of that group was taking a cholesterol-lowering drug (mostly statins). After nearly three years, Alzheimer's had progressed more slowly in people taking the drugs than in those with untreated high cholesterol or normal levels. Scores on a standardized exam (with a 30-point scale) used to test dementia declined 1.5 points a year for those taking cholesterol medication, compared with a drop of 2.4 points for the untreated high cholesterol group and 2.6 points for those with normal levels.

* WHO MAY BE AFFECTED BY THESE FINDINGS? Anyone with Alzheimer's disease, which affects about 4.5 million Americans -- a number that is projected to climb to nearly 16 million in 15 years.

* CAVEATS Whether the results varied by the type of cholesterol-lowering medication (statin, fibrate, etc.) taken was not determined. Participants taking the drugs at the start of the study had higher scores on the initial dementia test; some research has suggested that people with higher scores tend to decline less than those with lower scores.

* FIND THIS STUDY December issue of the Journal of Neurology, Neurosurgery, and Psychiatry; abstract available online at http://jnnp.bmjjournals.com.

* LEARN MORE ABOUT Alzheimer's disease at www.alzinfo.org and www.alz.org.

-- Linda Searing

The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.