OREGON STATE UNIVERSITY

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Genetics of cervical cancer raise concern about antiviral therapy in some cases

CORVALLIS, Ore. – A new understanding of the genetic process that can lead to cervical cancer may help improve diagnosis of potentially dangerous lesions for some women, and also raises a warning flag about the use of anti-viral therapies in certain cases – suggesting they could actually trigger the cancer they are trying to cure.

The analysis provides a clearer picture of the chromosomal and genetic changes that take place as the human papillomavirus sometimes leads to chronic infection and, in less than 1 percent of cases, to cervical cancer. It is the first to identify specific genes that are keys to this process.

Researchers say they want to emphasize, however, that the HPV vaccine commonly used by millions of women around the world is perfectly safe if done prior to infection with the virus. The concerns raised by this study relate only to viral therapies or possible use of a therapeutic vaccine after the virus has already been integrated into human cells.

“It’s been known for decades that only women with prior infection with HPV get cervical cancer,” said Andrey Morgun, an assistant professor and a leader of the study in the OSU College of Pharmacy. “In about 90 percent of cases it’s naturally eliminated, often without any symptoms. But in a small fraction of cases it can eventually lead to cancer, in ways that have not been fully understood.”

These findings were published recently in Nature Communications by researchers from Oregon State University and a number of other universities or agencies in the United States, Norway and Brazil. Collaborators at OSU included Natalia Shulzhenko, an assistant professor in the OSU College of Veterinary Medicine.

The study found that some pre-cancerous lesions can acquire a higher level of chromosomal imbalances in just a small number of cells. These new features appear to do two things at the same time – finally eliminate the lingering virus that may have been present for many years, and set the stage for the beginning of invasive cancer.

So long as the virus is not eliminated, it helps to keep under control viral oncogenes that have been integrated into the patient’s genome, researchers said.

“Some of what’s taking place here was surprising,” Morgun said. “But with continued work it should help us improve diagnosis and early monitoring, to tell which lesions may turn into cancer and which will not.”

The study also concludes it could be dangerous to use antiviral treatments or therapeutic vaccines with women whose lesions already show signs of HPV integration.

This may help explain why use of the antiviral drug interferon had inconclusive results in the past, in some studies of its value in treating cervical cancer. Patients with existing HPV lesions may wish to discuss findings of this study with their physicians before starting such treatments, researchers said.

Other researchers using a similar analytical approach also found key driver genes in melanoma, according to the report. This approach may have value in identifying genomic changes that are relevant to a range of malignant tumors, scientists said.

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Andrey Morgun, 541-737-3424

Research offers promising new approach to treatment of lung cancer

CORVALLIS, Ore. – Researchers have developed a new drug delivery system that allows inhalation of chemotherapeutic drugs to help treat lung cancer, and in laboratory and animal tests it appears to reduce the systemic damage done to other organs while significantly improving the treatment of lung tumors.

This advance in nanomedicine combines the extraordinarily small size of nanoparticles, existing cancer drugs, and small interfering RNA (siRNA) that shut down the ability of cancer cells to resist attack.

The combination of these forces resulted in the virtual disappearance of lung tumors in experimental animals.

Lung cancer is the leading cancer killer in both men and women. Despite advances in surgery, chemotherapy still plays a major role in its treatment. However, that treatment is constrained by the toxic effects of some drugs needed to combat it and the difficulty of actually getting those drugs into the lungs.

The findings were made by Oleh Taratula at Oregon State University and Tamara Minko and O. Garbuzenko at Rutgers University and the Cancer Institute of New Jersey. They were just published in the Journal of Controlled Release.

“Lung cancer damage is usually not localized, which makes chemotherapy an important part of treatment,” said Taratula, an assistant professor in the OSU College of Pharmacy and co-author on this study.  “However, the drugs used are toxic and can cause organ damage and severe side effects if given conventionally through intravenous administration.

“A drug delivery system that can be inhaled is a much more efficient approach, targeting just the cancer cells as much as possible,” he said. “Other chemotherapeutic approaches only tend to suppress tumors, but this system appears to eliminate it.”

A patent is being applied for on the technology, and more testing will be necessary before it is ready for human clinical trials, the researchers said.

The foundation of the new system is a “nanostructured lipid nanocarrier,” tiny particles much smaller than a speck of dust that are easily inhaled and also readily attach to cancer cells. This carrier system delivers the anticancer drug. However, it also brings siRNA that makes the cancer cell more vulnerable.

Cancer cells often have two forms of resistance to drugs – “pump” resistance that tends to pump the drug out of cells, and “nonpump” resistance that helps keep the cell from dying. The siRNA used in this system helps to eliminate both those forms of resistance, and leaves the cancer cell vulnerable to the drug being used to kill it.

By being inhaled, this system also avoids degradation of the chemotherapeutic agents that occurs when they are injected, researchers said. They arrive in more intact form, ready to do their job on lung cancer cells, while minimizing any side effects.

In more conventional chemotherapy for lung cancer, the drugs tend to accumulate in the liver, kidney and spleen, with much less of the drugs ever making it to the lungs. In this study, the amount of the drug delivered to the lungs rose to 83 percent with the inhalation approach, versus 23 percent with injection.

This work was supported by the National Cancer Institute, National Science Foundation, and the Department of Defense.

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Oleh Taratula, 541-737-3424

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Nanocarrier

Breakup of physician, drug company relationship could improve health care, cut cost

The study this story is based on is available in ScholarsArchive@OSU: http://bit.ly/19tKK06

 

PORTLAND, Ore. – A new report suggests that improved health care and significant reductions in drug costs might be attained by breaking up the age-old relationship between physicians and drug company representatives who promote the newest, more costly and often unnecessary prescription drugs.

This system, which has been in place for decades, at one time benefitted doctors by keeping them up to date on new medications, and always provided generous amounts of “free” samples to get patients started on the newest drugs, as well as other supplies and gifts.

But it’s actually a powerful marketing process into which the pharmaceutical industry pours tens of billions of dollars a year, with more than 90,000 drug representatives providing gifts and advice. There is one drug representative for every eight doctors in the United States.  This doesn’t necessarily serve the best interests of the patient in terms of economy, efficacy, safety or accuracy of information, experts say.

In one of the first reports of its type – titled “Breaking Up is Hard to Do” - researchers from Oregon State University, Oregon Health & Science University and the University of Washington outlined the deliberate process that one central Oregon medical clinic went through to remove drug company representatives from their practice. It explored the obstacles they faced and the ultimate, successful result. The findings were just published in the Journal of the American Board of Family Medicine.

The study found that avoiding conflicts of interest and becoming “pharma-free” is possible, but not easy.

“This is a culture change, one that’s already happening but still has a ways to go, especially in smaller private practices,” said Dr. David Evans, now with the Department of Family Medicine at the University of Washington, and previously a physician at the Madras, Ore., clinic featured in the article.

“The relationship between physicians and drug company representatives goes back generations, and it took a methodical, deliberate campaign to change it,” Evans said. “We ultimately decided something had to be done when our medical clinic was visited by drug reps 199 times in six months. That number was just staggering.”

Part of what allows the change, the researchers said, is that information on new medications is now available in many other forums. These may have less bias and be more evidence-based than the material traditionally provided by the pharmaceutical industry, which wanted to sell the latest product. In the Madras clinic, the physicians replaced information previously supplied by drug reps with monthly meetings to stay current on new medications, based on peer-reviewed, rather than promotional literature.

“In the past 5-10 years there’s been more of a move toward what we call ‘academic detailing,’ in which universities and other impartial sources of information can provide accurate information without bias,” said Daniel Hartung, assistant professor in the OSU College of Pharmacy. “This is being supported by some states and the federal government, and it’s a move in the right direction.”

Moves to separate the drug industry from the practice of medicine have been more aggressive in large medical teaching hospitals, Hartung said, but much less so in smaller private practice. Of the 800,000 physicians in the U.S., only 22 percent practice in academic settings, the study noted, and 84 percent of primary care physicians still have close relationships with the pharmaceutical industry.

The stakes can be high, the researchers said. In the study example, the “sample cabinet” of medications at the Madras clinic, provided for free by the pharmaceutical representatives, had an average price of $90 for a month’s supply of the medications. Less expensive, generic medications were identified for 38 of the 46 sample drugs, which would have cost $22 a month.

The new analysis explored the necessary steps that a private clinic can take to help address this concern, including quantifying the clinic-industry relationship, anticipating clinician and staff concerns, finding new ways to provide up-to-date information, and educating patients and the public.

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Daniel Hartung, 503-494-4720

Outpatients, hospital patients face different problems with antibiotic resistance

CORVALLIS, Ore. – A new study concludes that problems with antibiotic resistance faced by outpatients may be as bad as those in hospitalized patients, and that more studies of outpatients are needed – both to protect their health and to avoid inappropriate or unnecessary drug use.

Antibiotic resistance is a huge and growing problem in both hospital and outpatient settings. Failure to select an effective antibiotic, without appropriate consideration for this resistance, can increase the risk of continued illness or death.

While 126 million prescriptions a year for antimicrobial drugs are given to people outside of hospitals, less has been done with them, compared to inpatients, to monitor their levels of antibiotic resistance.

The new analysis examined more than 16,000 cultures for resistance to some commonly used antibiotics. It found that outpatients can face resistance issues that sometimes are similar to those of people in hospitals – but that these problems can also be either more or less severe.

The findings were reported in Diagnostic Microbiology and Infectious Disease by researchers from Oregon State University, Oregon Health and Science University, and Kaiser Permanente Northwest.

“Hospitals for some time have been producing what are called antibiograms, a compilation of data to provide insights into local problems with antibiotic resistance,” said Jessina McGregor, assistant professor in the OSU College of Pharmacy, who is an expert in antibiotic resistance issues and lead author on this study.

“Traditionally these findings have been shared with doctors to help them select the best antibiotics for their patients’ infections,” she said. “However, in many outpatient settings this same level of information has not been available. We found there are enough differences that we need to start doing more studies with the outpatient groups, in order to help doctors provide patients with the best possible care for their infections, and prevent the spread of resistance.”

The researchers also noted that more than half of all antibiotics prescribed to outpatients for acute respiratory infections are unnecessary. This can speed the resistance of bacteria to antibiotic treatment.

Antibiotic resistance historically began to show up in hospitals before it was found in the larger community, researchers say. Because of this, hospitals have been more aggressive in working to monitor, understand and prevent unnecessary antibiotic use.

As patient records increasingly become electronic, both in the hospital and in outpatient clinics, it will be possible for more health care systems to produce outpatient antibiograms, McGregor said, and that will be “a step in the right direction.”

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Jessina McGregor, 503-494-4722

Co-Q10 deficiency may relate to statin drugs, diabetes risk

CORVALLIS, Ore. – A laboratory study has shown for the first time that coenzyme Q10 offsets cellular changes that may be linked to a side-effect of some statin drugs - an increased risk of adult-onset diabetes.

Statins are some of the most widely prescribed drugs in the world, able to reduce LDL, or “bad” cholesterol levels, and the risk of heart attacks or other cardiovascular events. However, their role in raising the risk of diabetes has only been observed and studied in recent years.

The possibility of thousands of statin-induced diabetics is a growing concern, and led last year to new labeling and warnings by the Food and Drug Administration about the drugs, especially when taken at higher dosage levels.

The findings of the new research were published as a rapid communication in Metabolic Syndrome and Related Disorders, and offer another clue to a possible causative mechanism of this problem.

Pharmacy researchers at Oregon State University who authored the study said the findings were made only in laboratory analysis of cells, and more work needs to be done with animal and ultimately human studies before recommending the use of coenzyme Q10 to help address this concern.

“A number of large, randomized clinical trials have now shown that use of statins can increase the risk of developing type-2 diabetes by about 9 percent,” said Matthew K. Ito, an OSU professor of pharmacy and president-elect of the National Lipid Association.

“This is fairly serious, especially if you are in the large group of patients who have not yet had a cardiovascular event, but just take statin drugs to lower your risks of heart disease,” Ito said.

A suspect in this issue has been altered levels of a protein called GLUT4, which is part of the cellular response mechanism, along with insulin, that helps to control blood sugar levels. A reduced expression of GLUT4 contributes to insulin resistance and the onset of type-2 diabetes, and can be caused by the use of some statin drugs.

The statins that reduce cholesterol production also reduce levels of coenzyme Q10, research has shown. Coenzyme Q10 is needed in cells to help create energy and perform other important functions. And this study showed in laboratory analysis that if coenzyme Q10 is supplemented to cells, it prevents the reduction in GLUT4 induced by the statins.

Not all statin drugs, however, appear to cause a reduction in GLUT4.

The problems were found with one statin, simvastatin, that is “lipophilic,” which means it can more easily move through the cell membrane. Some of the most commonly used statins are lipophilic, including simvastatin, atorvastatin, and lovastatin. All of these statins are now available as generic drugs, and high dosage levels have been most often linked with the increase in diabetes.

Tests in the new study done with a “hydrophilic” statin, in this case pravastatin, did not cause reduced levels of GLUT4. Pravastatin is also available as a generic drug.

“The concern about increasing levels of diabetes is important,” Ito said. “We need to better understand why this is happening. There’s no doubt that statins can reduce cardiovascular events, from 25-45 percent, and are very valuable drugs in the battle against heart disease. It would be significant if it turns out that use of coenzyme Q10 can help offset the concerns about statin use and diabetes.”

Before that conclusion can be reached, the researchers said, additional studies are needed on coenzyme Q10 supplementation and the pathogenesis of statin-induced diabetes.

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Matthew K. Ito, 503-494-3657

College of Pharmacy

About the OSU College of Pharmacy: The College of Pharmacy prepares students of today to be the pharmacy practitioners and pharmaceutical sciences researchers of tomorrow by contributing to improved health, advancing patient care and the discovery and understanding of medicines.

Researchers discover genetic basis for eczema, new avenue to therapies

The publication this story is based on is available online at http://bit.ly/VUy4Im

 

CORVALLIS, Ore. – Researchers at Oregon State University today announced the discovery of an underlying genetic cause of atopic dermatitis, a type of eczema most common in infancy that also affects millions of adults around the world with dry, itchy and inflamed skin lesions.

The findings were just published in PLoS ONE, a professional journal, and may set the stage for new therapeutic approaches to this frustrating syndrome, which is difficult to treat and has no known cure. Eczema is also related to, and can sometimes cause asthma, a potentially deadly immune dysfunction.

Pharmaceutical scientists at OSU found in laboratory studies that eczema can be triggered by inadequate Ctip2, a protein and master regulator that affects other genetic functions. They have identified two ways in which improper function of Ctip2 can lead to eczema.

In a recent publication, they found that Ctip2 controls lipid biosynthesis in the skin, the fats that are needed to help keep skin healthy and hydrated. In the new study, they discovered that Ctip2 suppresses TSLP, a cytokine protein produced by skin cells that can trigger inflammation.

Levels of this inflammatory TSLP, which is ordinarily undetectable in human skin, were found to be 1,000 times higher in laboratory animals that had been genetically modified to have no Ctip2 production in their skin.

“In these studies, we’ve basically shown that inadequate Ctip2 is reducing the lipids in skin that it needs to stay healthy, protect itself and perform its function,” said Arup Indra, an associate professor in the OSU College of Pharmacy. “At the same time this can allow unwanted formation of proteins that trigger inflammation. The skin’s ability to resist inflammation is going down just as the amount of inflammation is going up, and the underlying reason is that Ctip2 is not doing its job.”

“Either or both of these problems can lead to eczema,” Indra said.

Atopic dermatitis is associated with a dysfunctional immune response, but researchers have never understood the underlying cause. Existing treatments use moisturizers to try to protect skin, and in difficult cases powerful steroid drugs can help, but they often have significant unwanted side effects, especially in long-term use.

“With a better understanding of just what is causing eczema on a genetic basis, we should be able to personalize treatments, determine exactly what each person needs, and develop new therapies,” Indra said. “This might be with topical compounds that increase Ctip2 expression in skin cells, or customized treatments to restore an individual person’s lipid profile. In the future, systemic epigenetic modification might even be possible.”

The creation at OSU of the laboratory model to study this issue is also of considerable importance, Indra said. There’s evidence it could be used to screen for drugs with potent anti-inflammatory activities.

Eczema is a persistent skin rash that can be fairly common in infants or youth, which some research indicates may be linked to food or pollen allergens. Most people outgrow it as they reach adulthood, but some suffer from the debilitating condition their entire life.

“Our skin is the largest organ in the human body and one of the most important,” Indra said. “It’s our first barrier of defense, is in a constant battle against external insults, is influenced by both genetics and the environment, and has to be finely tuned to do many jobs. In eczema, this process begins to break down.”

Eczema allows significant loss of fluids through the skin, allows allergens to penetrate, and in severe cases can cause a systemic inflammatory response.

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Arup Indra, 541-737-5775

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Normal skin
Normal skin


Inflamed skin

Inflamed skin

Educational event in Portland will address antibiotic use, resistance

PORTLAND, Ore. –For the third year, the College of Pharmacy at Oregon State University and the Oregon Health Authority will sponsor “AWARE at the Square” in Portland, a health education event about antibiotic use and resistance.

The event will be at Pioneer Courthouse Square in Portland on Friday, Nov. 16, from 7 a.m. to 4 p.m. OSU pharmacy students will be available to discuss these issues, as well as help people learn ways to prevent infection and talk to their doctor about when they really need antibiotics.

Flu shots will also be provided for free to adults who are either uninsured or have barriers to accessing the vaccination. Getting vaccinated is one of the best ways to stay healthy in the winter.

It’s important to recognize that antibiotics do not treat the cold or flu, said Jessina McGregor, an assistant professor in the OSU College of Pharmacy and an expert on antibiotic use and resistance. Using antibiotics when unnecessary may make it less likely that they will work when you really need them, she said. 

This is one of the key public health messages highlighted during this month’s national Get Smart about Antibiotics Week, which aims to educate the public about appropriate antibiotic use, increasing problems with resistance to antibiotics, and preventing infections.

“Antibiotics can be important, sometimes life-saving medications when we really need them, but too often they are taken unnecessarily or not taken properly,” McGregor said.

Colds and influenza, McGregor said, are caused by viruses, and antibiotics will not help people get better. Instead, these unnecessary uses can lead to development of resistance in bacteria, which poses a significant public health threat.

More information on these issues is available online from the Centers for Disease Control and Prevention at http://www.cdc.gov/getsmart/ or Oregon AWARE at http://www.healthoregon.org/antibiotics.

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Jessina McGregor, 503-494-5778

Researchers identify genetic basis of cardiac, craniofacial birth defects

CORVALLIS, Ore. – A group of researchers in Israel, the United States and other nations have made important advances in the rapidly expanding field of “regenerative medicine,” outlining for the first time  connections in genetic regulation that normally prevent birth defects in heart and facial muscles.

Some of these problems are surprisingly common – about 1 percent of all people have a congenital heart defect. This basic research will provide a road map to ultimately allow scientists to grow the cell types needed to repair such defects, from stem cells that can be generated from a person’s own body.

The findings were published online today in the Proceedings of the National Academy of Sciences.

“Advances in regenerative medicine and developmental biology can now happen because we no longer require human embryos to generate stem cells,” said Chrissa Kioussi, a co-author on the study and associate professor in the College of Pharmacy at Oregon State University. “The Nobel Prize this year was awarded to people who discovered how to make stem cells from adult biopsies.”

Patient-derived stem cells can in principle be turned into any needed cell type, Kioussi said. The key is understanding the exact regulatory process than tells cells what type they are supposed to turn into, she said, such as a cell on the outside of the left ventricle of the heart.

“Once we understand these genetic controls in sufficient detail, we can not only turn a skin cell into a stem cell, but also turn that stem cell into the type needed for the patient to recover,” Kioussi said. “We may eventually be able to grow replacement organs from the patient’s cells.”

In this study, researchers identified four specific “transcription factor” genes that control processes related to heart and head muscle formation. When there are defects in this process, the result can be death or a range of debilitating problems, from cleft palate to facial malformations and defective heart valves.

“There are about 20,000 genes in the human genome, but only 2,000 of the genes describe transcription factors,” Kioussi said. “These transcription factors control the output of genes, the genetic machinery. They collectively determine which of the 20,000 possible molecular machines is actually deployed in each particular cell type.”

Scientists have found that these transcription factors don’t work alone to define cell types in mammalian development – they function in small, self-stabilizing combinations of at least two or three.

The process moves rapidly after conception, and within one month most of the cells in the body “know” their cell type, based on the precise combination of transcription factors produced within them. When researchers understand how these stable transcription factor combinations get generated, they will know how to artificially generate these combinations in stem cells to convert them into the needed cell types.

Mammalian embryonic development is a process of self-construction, a series of transitions of “temporary” cell types on the way to adult cell types. A fertilized egg is essentially a stem cell with the potential to become any other cell type. At each intermediate stage, the “temporary” cell types become more restricted in what they can become, until they ultimately achieve and maintain the adult type.

“In this work and in regenerative medicine, we care a great deal about all of these steps of cell differentiation,” Kioussi said. “If you know all the steps it takes to get from here to there, you can identify what went wrong and find ways to fix it. This is being done already with some disease problems, and this work will move us closer to being able to repair heart and craniofacial defects.”

The task is complex, Kioussi said, but possible. Although there are 100 trillion cells in the human body, there are only about 100 adult cell types. Understanding and influencing the genetic specification of those cell types could revolutionize the treatment of many defects and diseases, Kioussi said.

This work was supported by the European Research Council, the Israel Science Foundation, the U.S. National Institutes of Health, and other agencies. The lead author was Eldad Tzahor at the Weizman Institute of Science in Israel, and other collaborators were from universities and agencies in the United Kingdom, India and Spain.

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Chrissa Kioussi, 541-737-2179

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Embryonic brain


Embryonic brain

Higher-dose use of certain statins often best for cholesterol issues

CORVALLIS, Ore. – A comprehensive new review on how to treat high cholesterol and other blood lipid problems suggests that intensive treatment with high doses of statin drugs is usually the best approach.

But some statins work much better for this than others, the review concluded, and additional lipid-lowering medications added to a statin have far less value. And medications, of course, should be considered after first trying diet, weight loss and exercise.

The review, published in the Annals of Pharmacotherapy, examined the range of treatment options for “dyslipidemia,” or concerns about LDL cholesterol that is too high; HDL cholesterol that is too low; elevated triglycerides; and other issues that affect millions of people around the world.

It concluded that use of statin drugs, which effectively lower LDL, or “bad” cholesterol, is appropriate for both moderate and high risk patients who have issues with their cholesterol levels, or may already have experienced a heart attack or angina as a result of cardiovascular disease.

But it also found that in most cases simply increasing the statin dose would offer the best protection against serious cardiovascular problems, more so than using other drugs or combinations of drugs.

“Statins are proven medications that can reduce heart attacks and strokes by about 30 percent in the patients that need them,” said Matt Ito, a professor of pharmacy practice at Oregon State University, author of the study and president-elect of the National Lipid Association.

“What we looked at here was whether adding other drugs or therapies to the use of statins could further reduce problems, and in most cases the research indicates that they didn’t help,” Ito said. “What did help was increasing the statin dose to higher levels within the range for which they are approved. And there did not appear to be a significant change in side effects based on any approved dosage.”

The goal with what the researchers called “intensive monotherapy,” or high doses of just one statin drug, was usually to reduce LDL cholesterol to 100 mg/dL or less – or 70 mg/dL or less for people who already have coronary disease, diabetes or other special risks. Failing that, the medication goal should be to at least cut the LDL level in half, Ito said.

For intensive monotherapy with an average patient, research indicates that only two of the most commonly prescribed statins are suitable:  atorvastatin and rosuvastatin. Others that are “not suitable for intensive monotherapy,” the review said, include fluvastatin, lovastatin, pitavastatin, pravastatin, and simvastatin.

All statin drugs, at lower dosages, can have value if less dramatic lowering of LDL levels is needed, the researchers said.

“The reaction to statin regimens varies with the individual, so some of these other drugs may also be able to accomplish the goals we’re seeking,” Ito said. “These recommendations are based on results with an average patient, but physicians may find some of their patients can do adequately well with other statins, or that they don’t need intensive monotherapy.”

Statin drugs are generally well tolerated but can be associated with some side effects, experts say, particularly myopathy, or muscle pain and damage. These are some of the factors considered in establishing safe and accepted dosages. Some of the available drugs at their highest accepted dosage have been shown to cut LDL levels more than others, Ito said, and are therefore the best candidates for intensive therapy.

Other medications sometimes given for dyslipidemia were shown to have less value or even pose additional risks, the review found. This includes fibrates to lower triglyceride levels; niacin to lower triglycerides and raise HDL levels; and omega-3 fatty acids that appeared safe, but added little in efficacy to what was already being accomplished with statin drugs.

“We found that only in patients with extremely high triglycerides and very low HDL would use of fibrates be appropriate to use in addition to statins,” Ito said. “Otherwise the increased risks outweigh the benefits, especially in women.” 

More detail on some of these issues, Ito said, can be found online at the web site of the National Lipid Association, lipid.org. A link for consumers called “Learn your Lipids” would be especially helpful, he said.

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Matthew Ito, 503-494-3657