Jewish World Review Dec. 6, 2002 / 1 Teves, 5763

Statins: More Good News

By Robert A. Wascher, M.D., F.A.C.S. | In the current issue of the journal Circulation, the impact of the cholesterol-lowering drug simvastatin on aortic (the large artery that arises directly from the heart) and carotid artery narrowing was assessed using magnetic resonance scanning. The statin class of drugs reduce the blood levels of "bad cholesterol" (LDL), and increase levels of "good cholesterol" (HDL). These medications have also been shown to reduce the blood levels of a protein linked to inflammation of diseased blood vessels (C-reactive protein), and to the progression of cardiovascular disease. While these drugs have been prescribed in order to reduce the likelihood of developing cardiovascular disease, their effects on preexisting arterial disease are less clear. In this study, the authors used a magnetic resonance imaging (MRI) scanner to measure arterial narrowing in 21 patients with elevated blood cholesterol levels.

At the beginning of the study, a total of 44 aortic and 32 carotid artery plaques were found in the 21 volunteers. All patients took simvastatin during the 2-year study period, and their aortas and carotid arteries were periodically reevaluated by MRI scanning. Following 12 months of simvastatin therapy, there was a 10% reduction in the thickness of the aortic wall thickness and an 8% reduction in carotid artery wall thickness. Additional average reductions in arterial wall thickness, ranging from 12-20%, were achieved following 18-24 months of simvastatin therapy. This study, therefore, shows that long-term treatment with simvastatin can not only slow down the progression of arterial atherosclerosis (narrowing of arteries due to cholesterol plaque formation), but may also actually help to reverse such pathologic changes.


The journal Circulation contains another interesting study. The drug Tamoxifen is often used to treat women with breast cancers that are sensitive to the female hormone estrogen. Tamoxifen selectively blocks the effects of estrogen on breast milk duct cells, thus reducing estrogen's stimulatory effects on breast cell growth. Tamoxifen has also been shown to reduce the risk of breast cancer by nearly 50% in women without a history of breast cancer, but with a history of preexisting risk factors for the disease. At the same time, Tamoxifen can mimic the effects of estrogen in certain tissues of the body, such as the bones and the uterus. The study looked at the effects of Tamoxifen on the thickness of the carotid artery. As cardiovascular disease progresses, the arterial walls become thicker, thus reducing the internal arterial diameter and, in time, limiting blood flow through the narrowed blood vessels.

A total of 67 women taking Tamoxifen for breast cancer were compared with 37 breast cancer patients who were not taking the anti-estrogen drug. The women were studied for an average of 2.4 years. Ultrasound measurements of the carotid arteries were performed at regular intervals. The study found that the women who took Tamoxifen had significantly less arterial thickening than the women who were not taking Tamoxifen.

The reduction in carotid artery thickening among the patients taking Tamoxifen was nearly equivalent to the amount of thickening that naturally occurs in adults over a 12-year period. This apparent cardiovascular protective effect of Tamoxifen is an intriguing finding in view of recent studies showing an increase in the incidence of cardiovascular disease among women who take supplemental estrogen (hormone replacement therapy) after menopause. Ultimately, only a large well-controlled study will be able to confirm the findings of this small preliminary study, and reveal whether or not the observed effects of Tamoxifen on arterial wall thickness actually translate into improvements in health outcomes.


Gallstone disease, or cholelithiasis, is a painful and occasionally life-threatening disease that arises when hard cholesterol stones form in the gallbladder. The gallbladder collects and concentrates bile from the liver, and then forcefully injects this concentrated bile into the intestinal tract during meals, where it helps to improve the absorption of dietary fats into the blood. Cholelithiasis affects women more than twice as often as men, most likely due to the effects of estrogen and pregnancy. Nearly 15 million American women have gallstone disease, while about 7 million men have this condition, or about 10-20% of the population. Nearly 1 million people will undergo surgery this year to have their gallstones and gallbladders removed. In addition to gender, obesity, increasing age, and number of previous full-term pregnancies are also linked with an increase in the risk of gallstone disease.

There is some data suggesting that coffee consumption may reduce the risk of gallstone disease. A new study in the current issue of the journal Gastroenterology looks at this possible link between coffee and gallstone disease. Nearly 81,000 women, aged 34-59 years, were enrolled into this study in 1980. Biennial surveys were taken from all patients, and the women's coffee consumption and the incidence of gallbladder surgery were then analyzed.

During the subsequent 20 years of follow-up, 7,811 of the study women underwent surgery for gallstone disease. The study determined that drinking 2-3 cups of coffee per day reduced the risk of cholelithiasis by 22%, while 4 cups of java per day reduced the risk of gallstone disease by 28%. Drinking 1 cup of coffee per day reduced the risk of cholelithiasis by only about 9%. The consumption of other caffeinated beverages also reduced the risk of gallstone disease, while decaffeinated coffee had no impact on gallstone risk. Thus, it appears that the chronic consumption of caffeinated beverages, including coffee, may be able to moderately reduce the risk of cholelithiasis.


Irritable bowel syndrome (IBS) affects as many as 20% of the population in the United States. As with cholelithiasis, more than twice as many women as men have been diagnosed with IBS. IBS is characterized by bouts of abdominal cramping and diarrhea, often alternating with periods of constipation. While many theories have been advanced as to the cause of IBS, the etiology is not known. As no physical cause for IBS has ever been convincingly demonstrated, IBS is characterized as a "functional disorder."

A new study in the current issue of Gastroenterology used a surgical approach to obtain biopsies of the small intestines of patients with IBS symptoms. A total of 10 patients (2 men and 8 women) were evaluated. In 9 out of the 10 patients, the intestinal biopsies revealed signs of inflammation involving the nerve cells within the intestinal wall, known as the myenteric plexus. Six of these 9 patients were also found to have nerve cell degeneration within the myenteric plexus. Although the reasons behind these intriguing findings are not yet clear, this small study does appear to show distinctive anatomic changes of the small intestine in patients with IBS. Further study will, therefore, be necessary to reproduce the findings of this small preliminary study, and to better understand why these nerve cell abnormalities arise in the intestines of IBS patients.

JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at the John Wayne Cancer Institute in Santa Monica, CA. Comment by clicking here.


11/22/02:Alcohol, HRT & the risk of breast cancer; hormone replacement therapy: more bad news; new vaccines may eliminate cervical cancer; more

11/15/02: The Effects of Diet & Exercise on Blood Pressure & Health; Growth Hormone & Sex Steroid Supplements & the Elderly; C-Reactive Protein & Cardiovascular Disease Risk

11/08/02: More Good News About Statin Drugs; Hormone replacement Therapy (HRT) & Alzheimer's Disease; A Role for Antibiotics in the Treatment of Vascular Disease?; more

11/01/02: Digoxin & gender; driving & degenerative disc disease; Coenzyme Q10 & Parkinson's Disease; Ginseng & erections; Viagra & stroke

10/25/02: Aspirin & coronary artery bypass surgery; glucosamine sulfate & progression of knee arthritis; hospital nurse staffing & patient mortality

10/18/02: Motor Vehicle Exhaust Pollution & Mortality; CT Scans, C-Reactive Protein & Heart Disease; Antiperspirant Use & the Risk of Breast Cancer; Atomic Bomb Radiation Exposure Update; more

10/04/02: Antioxidants & the Risk of Stomach Cancer; Best Way to Diagnose Appendicitis?; Coronary Artery Disease: Stent or Surgery?

09/27/02: Breast Feeding & the Risk of Asthma; HMOs & Quality of Care Scores; Red Wine & Vascular Disease

09/20/02: Dietary Folate & the Risk of Colorectal Cancer; Risks Associated with Smoking after Heart Attacks; BRCA1 Gene Mutation & the Risk of Breast & Non-breast Cancers; Breast Tissue Density & Inheritance

09/13/02: Dairy Products, Calcium, Vitamin D & the Risk of Breast Cancer; Efficacy of Nonprescription Smoking Cessation Aids; A Nutty Approach to Heart Disease Prevention; Update on Prostate Cancer

09/06/02: C-Reactive Protein & Estrogen Replacement Therapy; Walking Women & Cardiovascular Disease; Physical Activity Among Teenaged Girls

08/30/02: Babbling babies & brain function; homocysteine levels, vitamins & coronary artery disease; St. John's Wort & chemotherapy

08/16/02: A New Weapon Against Anthrax?; cataracts & motor vehicle accidents; gingko biloba takes a hit; air pollution & heart function during exercise; breast cancer genes & the estimated risk of breast cancer

08/09/02: Botulinum Toxin & Post-Stroke Spasticity; Intestinal Hormone Kills Appetite; Bone Marrow Cells Improve Blood Flow in Vascular Disease; Effectiveness of Restraining Orders on Domestic Violence

08/02/02: Mammography Saves Lives!; Obesity & the Risk of Heart Failure; High Sugar Diets & the Risk of Colon Cancer; Abuse During Childhood & Possible Effects of Genes on Antisocial Behaviors

07/26/02: Cancer: Nature vs. Nurture; Cardiorespiratory Fitness & Inflammation; Kidney Transplants from Cadaver Donors; Aircraft Cabin Air Recirculation & the Common Cold

07/19/02: PCBs & the Gender of Babies; Breastfeeding & the Risk of Breast Cancer; More Bad News About Hormone replacement Therapy

07/12/02: A cancer surgeon's perspective on hormone replacement therapy

07/08/02: Hormone replacement therapy & the risk of disease; more good news about statins; antioxidant vitamins & disease prevention; more

06/28/02: Antioxidants & the Risk of Alzheimer's Disease; Effects of Exercise on the Hearts of Patients with Mild Hypertension; Statins reduce cardiac events following angioplasty; more

06/21/02: Sex & violence and Advertising: Do Advertisers Get What they Pay For?; Don't Drink the Water (or the Salsa Either!); Vasectomy & Prostate Cancer Risk; Update on Smoking & Disease

06/14/02: Young Men, Obesity & Heart Disease; Breastfeeding & Obesity; Irritable Bowel Syndrome & rectal pain threshold; more data on cox-2 inhibitors & cancer; more

06/07/02: New coronary artery stent reduces risk of restenosis; possible cause of Parkinson's Disease identified; more

05/31/02: New biological insights into obesity & weight loss; broccoli kills cancer-causing stomach bug; anti-inflammatory drugs and the risk of heart attack

05/24/02: Molecular detection of tumor cells in the blood & prognosis; Cox-2 & breast/lung cancers; BRCA2 gene mutations & the risk of breast cancer; breast density & the risk of breast cancer

05/19/02: Moderate alcohol intake and blood sugar levels; more good news for tea drinkers; blood potassium levels & the risk of cardiovascular disease; ethnic differences in diabetic complications

05/10/02: Tea drinkers and the risk of death following heart attack; duration of breastfeeding & adult intelligence; abdominal aortic aneurysms: surgery or observation?

05/03/02: Risk of adverse drug reactions from newly released medications; preoperative beta-blockers may reduce heart bypass deaths; shape-shifting plastics may alter surgical practice; weight loss supplement may cause liver damage
04/26/02: Angry young men & risk of premature cardiovascular disease; stay-at-home dads & risk of cardiovascular disease; more on the effects of statins; dairy consumption and the risk of pre-diabetes; smallpox vaccine: good to the last drop?
04/19/02: Change your sex by drinking water?; Anti-inflammatory RXs may reduce growth of breast cancer cells; radiation treatment reduces repeat narrowing of bypass grafts
04/05/02: Fish & Omega-3 fatty acid consumption and cardiac health; news briefs
04/05/02: Can coffee reduce your risk of tooth decay?; exercise & blood pressure; a single high-fat meal reduces coronary artery function
04/01/02: Pre-diabetes: a newly defined category of health risk; teen television viewing and subsequent aggressive behavior; the benefits of strength training in the elderly; more ...
03/22/02: Bacteria, antibiotics & heart disease; mammograms: the debate continues; calcium & the risk of colon cancer ... and more
03/15/02: Mammography debate continues; statins & fracture risk; physical fitness & the risk of death; other intriguing findings
03/08/02: Blows to the chest & sudden cardiac death; air quality & the risk of lung cancer; tomatoes and your prostate
03/01/02: Diet & the risk of ovarian cancer; lifetime risk of developing high blood pressure; Osteoporosis prevention with a once-a-year injection?
02/26/02: The continuing controversy regarding screening mammography
02/22/02: Lowering body temperature after heart attack improves outcome; A silver lining for the chronically sleep-deprived?
02/15/02: Hormone replacement therapy & the risk of breast cancer; use it or lose it: Alzheimer's disease & cognitive stimulation; stress, divorce & death; child daycare, infections & parental guilt
02/08/02: Possible breakthrough in early cancer diagnosis; mammography: the controversy continues; CPR techniques revisited
02/01/02: Antibiotics in livestock feed & human disease; genetic detection of early colon cancer in the stool; genetic analysis of breast cancers may help decide treatment
01/25/02: Drug increases lifespan (if you're a fly...); workplace attitudes and smoking cessation; effects of inadequate sleep on surgeons
01/18/02: Lifelong effects of premature birth; smokers under the knife; aspirin and cardiovascular health
01/11/02: Estrogen levels in the blood & breast cancer risk; Heart attack: sex and survival; dangerous lettuce invaders
01/09/02: Cancer & aging: Two sides of the same coin?
01/04/02: Vitamin a & the risk of hip fracture in postmenopausal women; ovarian cancer risk and oral contraceptives
12/28/01: Magnetic Resonance Imaging (MRI) detects coronary artery disease; new development in obesity research; adverse childhood experiences & the risk of suicide attempts
12/21/01: Vaccination of children controls hepatitis a in the community; a possible cure for sickle cell disease; leptin and the risk of heart attacks
12/14/01: Chernobyl and the Risk of Thyroid Cancer in hildren; children & obesity; gastroesophageal reflux disease update
12/07/01: Update on school shootings; new implantable heart-assist device approved for further evaluation; prevention of fungal infections in pre-term babies
11/30/01: Flu vaccination in asthmatics; low-tar cigarettes are not less harmful; beans and your heart
11/21/01: Modified smallpox vaccine may reduce risk of cervical cancer; New approach to breast cancer diagnosis; New non-invasive prenatal diagnostic test for down's syndrome
11/16/01: Cholesterol-lowering drugs reduce risk of heart attack; supplemental radiation therapy reduces risk of breast cancer recurrence; brains of women may answer age-old questions
11/09/01: Bio-warfare (redux); my gray matter is bigger than yours; mad elk disease?
11/02/01: Making sense of bio-warfare
10/26/01: The impact of mammography on deaths due to breast cancer; diet & exercise may slow cancer cell growth; antidepressants and the risk of heart disease
10/19/01: New insights into autism; the wiley appendix
10/12/01: More bad news about obesity links to other diseases…Hey dad, can I borrow the car keys?
10/05/01: California leads nation in reduction of tobacco-related disease; exercise as an antidepressant?
09/25/01: Advances in the detection of breast cancer; primary care physician awareness of peripheral arterial disease; arsenic in the water
09/17/01: In perspective
09/12/01: Genes may hold secret to long life; men and women: cognitive function in the elderly; physical activity, obesity and the risk of pancreatic cancer
09/05/01: English milk cows prefer Beethoven and Simon & Garfunkel over Bananarama; new prostate cancer prevention study: looking for a few good men; exercise & diet can help prevent diabetes
08/28/01: Arthritis drugs may be linked with increased risk of heart disease; errors in blood clotting tests can be fatal; infant soy formula not associated with reproductive side effects

© 2002, Dr. Robert A. Wascher