Statins’ Preventive Effects Evident Years After Stopping
Treatment with pravastatin for 5 years may lower the risk for coronary events for up to 10 additional years, according to a New England Journal of Medicine report.
Some 5800 men with hypercholesterolemia who had been randomized to either daily pravastatin or placebo in a 5-year trial were followed for an additional 10 years. (After the trial, roughly a third of both groups took statins, but their long-term outcomes were assigned to their original groups).
The pravastatin group, which had a 40% risk reduction in cardiovascular deaths or nonfatal infarction during the trial, had an 18% reduction in the post-trial period. Similar reductions occurred in other composite cardiovascular endpoints.
“There should no longer be any doubt” about the beneficial effects of lowering LDL cholesterol in preventing and treating CHD, an editorialist writes. The remaining questions, he says, are when treatment should start and what the target LDL levels should be.
Published in Physician’s First Watch October 11, 2007
Cochlear Implants Linked to Bacterial Meningitis Cases
The FDA reminded physicians on Wednesday that patients with cochlear implants for inner-ear malformations, especially implants with a positioner, are at risk for bacterial meningitis from Streptococcus pneumoniae. This warning follows the deaths of two children within the past years, ages 9 and 11 years, who had implants with a positioner and were not fully vaccinated. (Only one implant model has a positioner, and it was withdrawn from the market 5 years ago).
To decrease the risk for meningitis in this population, the FDA recommends:
- following the CDC’s vaccination guidelines;
- educating implant recipients and their caregivers about the early signs of meningitis;
- treating middle ear infections early;
- considering prophylactic antibiotics perioperatively.
Published in Physician’s First Watch October 11, 2007
Hormonal Therapy After Prostatectomy May Increase Cardiovascular Death
Men who receive androgen-deprivation therapy (ADT) after undergoing prostatectomy for prostate cancer
may be at increased risk for cardiovascular death, reports an industry-funded study in the Journal of the National Cancer Institute.
Researchers examined outcomes among nearly 5000 patients who had been treated for localized prostate cancer; two-thirds had undergone radical prostatectomy, while the rest received nonsurgical therapy. Overall, 20% also received ADT (median duration, 4 months).
During a median follow-up of 4 years, ADT use was associated with increased risk for cardiovascular death among prostatectomy patients (adjusted hazard ratio, 2.6). For patients treated non-surgically, a higher 5-year estimate of cardiovascular death with ADT use, observed only in patients 65 or older, did not achieve statistical significance.
The authors say their findings “underscore the importance of careful cardiovascular evaluation and intervention before initiating ADT in patients with localized prostate cancer.”