Blog | Monday, October 7, 2013

QD: News Every Day--High-dose statins reduced gum inflammation in heart disease patients

Statins reduced inflammation associated with gum disease, suggesting that alleviating gum disease may also reduce inflammation in the arteries, a study found.

Researchers conducted a double-blind, randomized study among patients with heart disease or at risk for it, recruited from 10 U.S. centers to take either 10 mg or 80 mg atorvastatin daily for 12 weeks and undergo PET/CT scans at baseline, 4 and 12 weeks.

Results appeared online Oct. 2 in the Journal of the American College of Cardiology. The study was funded by Merck and company employees participated in the study.

The 59 patients included in the final analysis showed a significant reduction in gum inflammation after as few as four weeks of treatment with the high-dose statin, and improvement in gum inflammation tracked closely with improvement in atherosclerotic disease.

PET scans recorded a normal distribution of uptake of the contrast medium in both statin treatment groups at baseline, week 4 and 12, and there was a significant reduction in periodontal contrast medium uptake with high vs. low dose atorvastatin at 12 weeks. The impact of high-dose atorvastatin on periodontal activity remained significant after adjusting for age and gender, diabetes mellitus and smoking, and prior coronary artery disease and baseline HDL, LDL and CRP levels.

The effect of high-dose statin was more notable in subjects with imaging evidence of periodontal disease at baseline and the difference in changes in periodontal disease between treatment groups was significant starting at 4 weeks.

The authors speculated that statins may exert an additional pleiotropic effect of reducing non-arterial inflammation, such as inflamed tissues such as the periodontium, although authors noted that statins may affect both periodontal and arterial inflammation independently without a link between these two tissues. Patients with heart disease and stroke should inform their physicians about any significant gum disease and should be particularly careful to follow existing guidelines for tending to gum disease, the authors noted.

An accompanying editorial noted three potential mechanisms of action for statins, beyond their role in lowering cholesterol: lowering all apolipoprotein B-containing lipoproteins (including remnants) to lowering lipid build-up in blood vessels; reducing systemic subclinical inflammation; and changing the characteristics of early atherosclerotic plaque, including delipidation, regression, reducing plaque-level inflammation, and plaque stabilization.

The editorialists wrote, “The question of who should be treated with statins over what time course is one of the most hotly debated in modern medicine. While statins certainly reduce atherogenic lipoproteins (Paradigm #1), the 2 reports from this intriguing … feasibility study suggest that high-dose statins also reduce extraarterial inflammation (Paradigm #2) and inflammation within atherosclerotic plaque (Paradigm #3). Ultimately, we hypothesize that relative importance of statin’s actions—within the framework of our proposed paradigms—may be population dependent.”