Low-dose Aspirin Linked to Reduced Liver Cancer Risk

Among adults at high risk of liver cancer, those who took low-dose aspirin were less likely to develop the disease or to die from liver-related causes. The findings come from an analysis published in the New England Journal of Medicine and conducted by a team led by investigators at the Karolinska Institutet, in Sweden, and Massachusetts General Hospital (MGH).

“Rates of liver cancer and of mortality from liver disease are rising at an alarming pace in U.S. and European countries. Despite this, there remain no established treatments to prevent the development of liver cancer, or to reduce the risk of liver-related death,” said lead author Tracey Simon, MD, MPH, investigator in the Division of Gastroenterology and Hepatology at MGH.

For the analysis, investigators examined information from Swedish registries on 50,275 adults who had chronic viral hepatitis, a type of liver infection that is caused by the hepatitis B or C virus and is the most common risk factor for liver cancer. Over a median follow-up of nearly 8 years, 4.0% of patients who took low-dose aspirin (less than 163mg/day) and 8.3% of nonusers of aspirin developed liver cancer. Aspirin users had a 31% lower relative risk of developing liver cancer.

Importantly, the study showed that the longer a person took low-dose aspirin, the greater the benefit. Compared with short-term use (3 months to 1 year), the risk of liver cancer was 10% lower for 1-3 years of use, 34% lower for 3-5 years of use, and 43% lower for 5 or more years of use.

Also, liver-related deaths occurred in 11.0% of aspirin users compared with 17.9% of nonusers over 10 years, for a 27% lower risk.

The benefits were seen regardless of sex, severity of hepatitis, or type of hepatitis virus (B or C). The risk of internal bleeding–a concern when taking aspirin long-term–was not significantly elevated among aspirin users.

“This is the first large-scale, nationwide study to demonstrate that the use of aspirin is associated with a significantly reduced long-term risk of liver cancer and liver-related mortality,” said senior author Jonas F. Ludvigsson, MD, PhD, of the Department of Medical Epidemiology and Biostatistics at the Karolinska Institutet.?

The investigators noted that prospective randomized controlled trials are needed to test the benefits of aspirin for patients affected by liver disease.

Source: EurekAlert!

Study: Heart Drug Combos Might Also Lower Your Dementia Risk

Certain combinations of cholesterol and blood pressure drugs may do more than help the heart — they might also lower a person’s risk of dementia, a new study finds.

The drugs in question include two common types of blood pressure medications — ACE inhibitors and angiotensin II receptor blockers (ARBs) — as well as cholesterol-lowering statins.

It’s long been known that keeping blood pressure and cholesterol under control is important for a healthy heart. But “this study tells us there might be certain combinations of drugs that have additional benefits for Alzheimer’s and other dementias beyond the management of those targeted conditions,” study co-author Douglas Barthold said in a University of Southern California news release.

Barthold is a research assistant professor in the department of pharmacy at the University of Washington in Seattle.

In the study, a team led by USC researcher Julie Zissimopoulos tracked 2007-2014 data from nearly 700,000 Medicare beneficiaries. The participants were ages 67 and older, and had used both a high blood pressure drug and a cholesterol-lowering statin drug for the two previous years. None had been diagnosed with dementia, and they had never taken any Alzheimer’s disease-specific medications.

The use of the statins pravastatin and rosuvastatin, combined with ACE inhibitors or angiotensin II receptor blockers (ARBs) for high blood pressure, was associated with a reduced risk for dementia, compared to other combinations of drugs.

One combination — pravastatin or rosuvastatin in combination with ARBs — was especially good at lowering the risk, with men benefiting even more than women.

For example, using a combination of ARBs and pravastatin was associated with a 21% lower risk of dementia diagnosis over the seven years of the study, compared to other combinations of drugs, according to the study.

Dementia affects about 7 million Americans and that number is expected to increase to 12 million over the next two decades.

“We don’t currently have drugs that are proven to treat dementia, but even small delays in onset can dramatically reduce the burden on patients, caregivers, and the health system as a whole,” Zissimopoulos said in the release. She directs the Aging and Cognition program at USC’s Center for Health Policy and Economics. “Our research found dementia risk may be reduced with specific combinations of drug treatments for vascular health.”

If these findings are replicated in future research, they might lead to specific combinations of statins and high blood pressure drugs being recommended to reduce the risk of Alzheimer’s disease and related dementias, the researchers said.

Two experts in brain and heart health said the new findings make sense, given links between the two organs.

“Yet another study that says heart health equals brain health,” said Dr. Gayatri Devi, a neurologist and psychiatrist at Lenox Hill Hospital in New York City.

She said that besides using meds to better your heart health, people interested in keeping their brain healthy should consider “eating a Mediterranean diet, doing aerobic exercise 30-45 minutes three to four days a week, maintaining healthy sleep habits and having community involvement.”

Dr. Guy Mintz directs cardiovascular health at the Sandra Atlas Bass Heart Hospital in Manhasset, N.Y. Reading over the findings, he said that “this choice of medications make sense because not only do ARBs reduce blood pressure, but they have an anti-inflammatory effect,” as do statins — and inflammation negatively affects blood vessel health in the brain.

“As we move into an era of precision medicine, the idea of targeted combination therapies for hypertension and cholesterol in patients over 67 years of age — translating to better vascular health in the brain and leading to a reduction of brain dysfunction — is exciting and warrants further research,” Mintz said.

The study was published recently in the journal PLOS One.

Source: HealthDay


Today’s Comic

Repurposed Antidepressant Could be a New Treatment for Recurrent Prostate Cancer

Leigh Hopper wrote . . . . . . . . .

n antidepressant in use for decades, repurposed to fight prostate cancer, shows promise in helping patients whose disease has returned following surgery or radiation, a pilot study at USC shows.

The drug — an MAO inhibitor called phenelzine — represents a potential new treatment direction with fewer side effects for men with recurrent prostate cancer, researchers said.

“To our knowledge, this study is the first clinical trial of an MAO inhibitor in cancer patients,” said senior author Jean Shih, a University Professor at the USC School of Pharmacy who has studied the enzyme MAO, or monoamine oxidase, for four decades.

The research appears in the journal Prostate Cancer and Prostatic Diseases.

“If our findings are confirmed, this could part of a new avenue for patients that could avoid undesirable side effects of standard therapies,” said first author Mitchell Gross, a medical oncologist and research director at the Lawrence J. Ellison Institute for Transformative Medicine of USC. Gross and Shih have been collaborating for several years to bring her research out of the lab and into the clinic.

In this study, 11 of 20 participants had a measurable decline in their PSA levels after 12 weeks of twice-a-day treatment, with the greatest decline in PSA being a 74% drop. PSA stands for prostate-specific antigen. Among men treated for prostate cancer, elevated PSA levels can indicate that prostate cancer cells are still circulating in the body.

How MAO inhibitors can help prostate cancer patients

Prostate cancer is the second most common cancer — behind skin cancer — diagnosed in men in the United States, with about 174,000 cases diagnosed each year. For most patients, prostate cancer is treated with surgery, radiation or a combination of the two.

After surgery, a patient’s PSA should be close to zero. However, in about one-third of patients, the PSA level rises again, indicating the cancer has returned. Hormone therapy is a standard treatment for recurrent prostate cancer, but it comes with serious side effects that impact quality of life.

That’s where MAO inhibitors may be able to help.

MAO inhibitors treat depression by readjusting levels of neurotransmitters such as serotonin and dopamine in the brain. The downside is that the medication requires dietary changes and careful avoidance of drug interactions to prevent serious side effects.

In prostate cancer, MAO inhibitors disrupt androgen receptor signaling — the main growth pathway for prostate cancer. Previous studies with animals and human prostate cancer cell lines showed that MAO inhibitors decreased the growth and spread of prostate cancer, the researchers found.

Because the MAO inhibitor phenelzine is already FDA-approved, the researchers were able to rapidly design and implement a pilot study to test the drug’s ability to fight cancer.

Antidepressant lowers PSA levels

For this study, researchers enrolled 20 participants who had been treated for prostate cancer and who had elevated PSA levels. Patients received the MAO inhibitor phenelzine twice a day for 12 weeks. Fifty-five percent of the men experienced PSA declines; five of them saw PSA level declines of 30% or more; two participants saw decreases of 50% or more.

Three patients had to drop out due to dizziness or hypertension.

The main limitations of the study include the lack of a placebo comparison group and the small sample size, researchers said. Additional studies are planned, and Shih has patented a second-generation MAO inhibitor tagged with a substance that could help doctors see where the cancer has spread.

Source: University of Southern California


Today’s Comic

Research Suggests Statins Could Lower Ovarian Cancer Risk

A genetic study has found evidence to suggest that women who take statins in the long term could be less likely to develop ovarian cancer, according to new research funded by Cancer Research UK published recently.

The same result was also found in women who carry the BRCA1/2 gene fault. Having the BRCA1/2 fault puts women at a higher risk of ovarian cancer than the general population.

The research published in JAMA studied genes and the extent to which they inhibit the enzyme HMG-CoA reductase – which is responsible for regulating cholesterol in the body – and is the exact enzyme targeted by statin drugs to reduce cholesterol.

While the study suggests that statins could lower ovarian cancer risk, more research needs to be done specifically looking at their use and impact on women’s risk of developing the disease.

The researchers based at the University of Bristol looked at 63,347 women between the ages of 20 and 100 years old, of whom 22,406 had ovarian cancer. They also looked at an additional 31,448 women who carried the BRCA1/2 fault, of whom 3,887 had ovarian cancer. The study used an approach called Mendelian randomization, which involves analysing the genetic data from thousands of people.

Statins may protect against the development of ovarian cancer because they’ve been shown to induce apoptosis – one of the body’s ways of getting rid of old, faulty or infected cells – and to stop tumours from growing in laboratory studies. Another line of thought is that statins lower circulating cholesterol, which helps regulate cell growth, though this research suggests that lower circulating cholesterol was not the method by which statins may reduce ovarian cancer risk.

The findings suggest that long-term statin use could be associated with an estimated 40% reduction in ovarian cancer risk in the general population, although the estimate comes from looking at gene variation rather than statins themselves, and the exact mechanism by which these genes are associated with lower ovarian cancer risk is unclear.

Ovarian cancer is the 6th most common cancer in women in the UK. There are around 7,400 cases each year, and out of those with a known stage at diagnosis, almost 6 in 10 are diagnosed at a late stage. Around 4,100 women die from the disease every year in the UK.

There is no test that reliably picks up ovarian cancer at an early stage, so chemoprevention could be an important approach to saving lives.

Professor Richard Martin, from the University of Bristol, said: “Our findings open up the possibility of repurposing a cheap drug to help prevent ovarian cancer – especially in women who are at a higher risk. It’s incredibly interesting that women whose bodies naturally inhibit the enzyme targeted by statins have a lower risk of ovarian cancer, but we don’t recommend anyone rushes to take statins specifically to reduce ovarian cancer risk because of this study.

“It’s a promising result and I hope it sparks more research and trials into statins to demonstrate conclusively whether or not there’s a benefit.”

Dr Rachel Orritt, Cancer Research UK’s health information manager, said: “This study is a great first step to finding out if statins could play a role in lowering ovarian cancer risk, and justifies future research into this area.

“But there’s not yet enough evidence to know if statins themselves could reduce the risk of developing ovarian cancer safely. And it’s important to remember that the risk of developing ovarian cancer depends on many things including age, genetics and environmental factors. Speak to your doctor first if you have any concerns about your risk.”

Source: EurekAlert!

Researchers Challenge New Guidelines on Aspirin in Primary Prevention

Giselw Galoustian wrote . . . . . . . . .

The most recent guidelines for primary prevention recommend aspirin use for individuals ages 40 to 70 years who are at higher risk of a first cardiovascular event, but not for those over 70. Yet, people over 70 are at increasingly higher risks of cardiovascular events than those under 70. There has been considerable confusion from recently reported results of three large-scale randomized trials of aspirin in high risk primary prevention subjects, one of which showed a significant result, but the other two, based possibly on poor adherence and follow up, did not. As a result, health care providers are understandably confused about whether or not to prescribe aspirin for primary prevention of heart attacks or strokes, and if so, to whom.

In a commentary published online ahead of print in the American Journal of Medicine, researchers from Florida Atlantic University’s Schmidt College of Medicine and collaborators from the University of Wisconsin School of Medicine and Public Health, and the Harvard Medical School and Brigham and Women’s Hospital, provide guidance to health care providers and their patients. They urge that to do the most good for the most patients in primary care, health care providers should make individual clinical judgement about prescribing aspirin on a case-by-case basis.

“All patients suffering from an acute heart attack should receive 325 mg of regular aspirin promptly, and daily thereafter, to reduce their death rate as well as subsequent risks of heart attacks and strokes,” said Charles H. Hennekens, M.D., Dr.P.H., senior author, the first Sir Richard Doll Professor, and senior academic advisor in FAU’s Schmidt College of Medicine. “In addition, among long-term survivors of prior heart attacks or occlusive strokes, aspirin should be prescribed long-term unless there is a specific contraindication. In primary prevention, however, the balance of absolute benefits, which are lower than in secondary prevention patients, and risks of aspirin, which are the same as in secondary prevention, is far less clear.”

The researchers emphasize that, based on the current totality of evidence, any judgments about prescribing long-term aspirin therapy for apparently healthy individuals should be based on individual clinical judgments between the health care provider and each of his or her patients that weighs the absolute benefit on clotting against the absolute risk of bleeding.

The increasing burden of cardiovascular disease in developed and developing countries underscores the need for more widespread therapeutic lifestyle changes as well as the adjunctive use of drug therapies of proven net benefit in the primary prevention of heart attacks and strokes. The therapeutic lifestyle changes should include avoidance or cessation of smoking, weight loss and increased daily physical activity, and the drugs should include statins for lipid modification, and multiple classes of drugs likely to be necessary to achieve control of high blood pressure.

“When the magnitudes of the absolute benefits and risks are similar, patient preference assumes increasing importance,” said Hennekens. “This may include consideration of whether the prevention of a first heart attack or stroke is a more important consideration to a patient than their risk of a gastrointestinal bleed.”

Individual clinical judgement by health care providers about prescribing aspirin in primary prevention may affect a relatively large proportion of their patients. For example, primary prevention patients with metabolic syndrome, a constellation of overweight and obesity, hypertension, high cholesterol, and insulin resistance, a precursor to diabetes mellitus, affects about 40 percent of Americans over age 40. Their high risks of a first heart attack and stroke may approach those in survivors of a prior event.

“General guidelines for aspirin in primary prevention do not seem to be justified,” said Hennekens. “As is generally the case, the primary care provider has the most complete information about the benefits and risks for each of his or her patients.”

According to the United States Centers for Disease Control and Prevention, more than 859,000 Americans die of heart attacks or stroke every year, which account for more than 1 in 3 of all U.S. deaths. These common and serious diseases take a very large economic toll, costing $213.8 billion a year to the health care system and $137.4 billion in lost productivity from premature death alone.

Source: Florida Atlantic University