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There is not enough evidence to recommend the widespread use of statins in people with no previous history of heart disease, according to a new Cochrane Systematic Review. Researchers say statins should be prescribed with caution in those at low risk of cardiovascular disease (CVD).

CVD is the most common cause of death, accounting for nearly a third of all deaths worldwide. Cholesterol-lowering statins are first line treatments for heart patients and the benefits are well established. However, there is less evidence that statins are beneficial for preventing heart problems in those who have no history of CVD. Given that low cholesterol has been shown to increase the risk of death from other causes, statins may do more harm than good in some patients.

The researchers reviewed data from 14 trials involving 34,272 patients. Outcomes in patients given statins were compared to outcomes in patients given placebos or usual care. Combined data from eight trials involving 28,161 patients that provided data on deaths from all causes showed that statins reduced the risk of dying from 9 to 8 deaths for every 1000 people treated with statins each year. Statins reduced fatal and non-fatal events, including heart attack, stroke and revascularization surgery, as well as blood cholesterol levels.

However, the researchers say that the conclusions of their review are limited by unclear, selective and potentially biased reporting and that careful consideration should be given to patients' individual risk profiles before prescribing statins.

"It is not as simple as just extrapolating the effects from studies in people who have a history of heart disease," said lead researcher Fiona Taylor, from the Cochrane Heart Group at the London School of Hygiene and Tropical Medicine in London, UK. "This review highlights important shortcomings in our knowledge about the effects of statins in people who have no previous history of CVD. The decision to prescribe statins in this group should not be taken lightly."

The researchers point out that all but one of the trials they reviewed were industry-sponsored. "We know that industry-sponsored trials are more likely to report favourable results for drugs versus placebos, so we have to be cautious about interpreting these results," said Taylor. "The numbers eligible for treatment with statins are potentially great so there might be motivations, for instance, to stop trials earlier if interim results support their use."

A separate Cochrane Systematic Review, conducted by some of the same authors, considered the effects of combined approaches to reducing the risk of heart disease, including using education and counselling to encourage people to change their diets and stop smoking. The authors concluded that combined interventions had little or no impact on deaths or disease caused by CVD. In an editorial accompanying the reviews, Carl Heneghan, University of Oxford, concluded that, "Although various multiple prevention strategies exist, the most effective and cost-effective intervention for primary prevention in adults at low risk currently remains unclear."

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Depending on the level of smoking and dietary vitamin C intake, vitamin E supplementation may extend the life-span of restricted groups of men, according to a study published in the Age and Ageing.

Several large randomized trials of humans found that vitamin E supplementation does not reduce mortality. However, the average effect on mortality in a group of people with a wide age range may mask an effect of vitamin E on the life-span.

Dr. Harri Hemila, and Professor Jaakko Kaprio, of the University of Helsinki, Finland, studied the age-dependency of vitamin E effect on mortality in the large randomized trial (Alpha-Tocopherol Beta-Carotene Cancer Prevention Study) which was conducted in Finland between 1985-1993. Their study was restricted to follow-up period over 65 years and 10,837 participants contributed to the analysis.

Among all analyzed participants, vitamin E had no effect on mortality when participants were 65 to 70 years old, but reduced mortality by 24% when participants were 71 or older.

Among 2,284 men with dietary vitamin C intake above the median who smoked less than a pack of cigarettes per day, vitamin E extended life-span by two years at the upper limit of the follow-up age span. In the other participants, consisting of 80% of the cohort, vitamin E did not affect mortality, which shows that vitamin E is no panacea for extending life expectancy.

The researchers concluded that "if vitamin E influences the life-span, it is possible that a benefit on the oldest participants might be camouflaged by the large middle-aged majority of study participants". Therefore, they propose that it might be useful to analyze the effect of vitamin E supplementation in large controlled trials by the age of the participant at the follow-up and not just by the time after randomization that has been customary.

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The notion that feeling good may be good for your health is not new, but is it really true? A new article published in Current Directions in Psychological Science, a journal of the Association for Psychological Science, reviews the existing research on how positive emotions can influence health outcomes in later adulthood.

“We all age. It is how we age, however, that determines the quality of our lives,” said Anthony Ong of Cornell University, author of the review article. The data he reviews suggest that positive emotions may be a powerful antidote to stress, pain, and illness.

There are several pathways through which a positive attitude can protect against poor health later in life. For example, happier people might take a proactive approach to aging by regularly exercising and budgeting time for a good night’s sleep. Alternately, these people may avoid unhealthy behaviors, such as smoking and risky sex. The benefits of these healthy lifestyle choices may become more important in older adults, as their bodies become more susceptible to disease.
An optimistic outlook has also been shown to combat stress—a known risk factor for a lot of disease. Studies have found that people with stronger positive emotions have lower levels of chemicals associated with inflammation related to stress. Also, by adopting a positive attitude people may even be able to undo some of the physical damage caused by stress.

Ong, a developmental psychologist, became interested in the study of positive emotion during graduate school when he learned about what researchers call the paradox of aging: Despite the notable loss of physical function throughout the body, a person’s emotional capacity seemed to stay consistent with age. Ong speculates that if positive emotions are indeed good for

• 5 stalks green asparagus, tough ends removed
• 1 can (15 oz.) white beans, rinsed and drained
• 1 orange bell pepper, seeded and chopped
• 1/2 cup finely chopped red onion
• 1 tbsp. extra-virgin olive oil
• 2 tbsp. freshly squeezed lemon juice
• 1 tsp. dijon mustard
• Salt and pepper, to taste
• 1 cup leafy salad greens, loosely packed

Per serving:
134 calories, 6g total fat (<1g saturated fat), 16g carbohydrates, 4g protein, 5g dietary fiber, 156mg sodium.

Adapted from the American Institute for Cancer Research Newsletter, Spring 2004, Issue 83, p. 6. http://www.aicr.org/.

Start with one of the prepackaged vegetable slaw mixes and add more vegetables to make it tastier and more unique. Here we’ve added red pepper, zucchini, and the less familiar fennel, a crunchy vegetable with a mild anise flavor. If you don’t like the flavor of anise, substitute celery.

• 1 (16 ounce) package preshredded broccoli slaw or cabbage slaw
• 1 cup shredded carrots
• 1 cup thinly sliced fennel or celery
• 1 large red pepper, julienned (about 1 cup)
• 2 small zucchini, julienned (about 2 cups)
• 1/2 cup canola or soybean oil mayonnaise
• 1/4 cup fresh-squeezed orange juice
• 1/2 tsp grated orange rind
• 1 tsp celery seed
• Coarse salt and freshly ground black pepper to taste

Note: For a spunkier slaw, omit the celery seed, orange juice, and rind from the dressing; add prepared horseradish to taste. Yields 16 servings; serving size 1/2 cup.

Per serving:
71 calories, 1.9g protein, 7.2g carbohydrates, 2.6g fiber, 60mg sodium, 2.1g fat, 2mg cholesterol.

Source: Eat, Drink, and Be Healthy by Walter C Willet, MD

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Many newspapers are reporting on new research about statins - this report is typical:

But not according to the most recent review of the many trials investigating their effectiveness, published yesterday. It suggests that for three quarters of those taking them, they offer little or no value, while exposing millions to the hazard of undesirable side-effects.

But this is lousy reporting - the actual research conclusion is: "All cause mortality. coronary heart disease and stroke events were reduced with the use of statins....Taking statins did not increase the risk of adverse effects such as cancer." No mention of undesirable side-effects.

The researchers mainly criticized the quality of the research, and advised exercising caution:

"There was evidence of selective reporting of outcomes, failure to report adverse events and inclusion of people with cardiovascular disease. Only limited evidence showed that primary prevention with statins may be cost effective and improve patient quality of life. "

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A European study investigating the links between diet and disease has found that people who consume more fruit and vegetables have a lower risk of dying from ischaemic heart disease -- the most common form of heart disease and one of the leading causes of death in Europe. However, the authors point out that a higher fruit and vegetable intake occurs among people with other healthy eating habits and lifestyles, and that these factors could also be associated with the lower risk of dying from IHD.

The study is published online on January 19 in the European Heart Journal.

Data analysed from the European Prospective Investigation into Cancer and Nutrition (EPIC) Heart study has shown that people who ate at least eight portions of fruit and vegetables a day had a 22% lower risk of dying from IHD than did those who consumed fewer than three portions a day. A portion weighed 80 grams, equal to a small banana, a medium apple, or a small carrot.

Dr Francesca Crowe of the Cancer Epidemiology Unit at the University of Oxford, UK, and the first author of the paper by the EPIC study collaborators, said: "This study involved over 300,000 people in eight different European countries, with 1,636 deaths from IHD. It shows a 4% reduced risk of dying from IHD for each additional portion of fruit and vegetables consumed above the lowest intake of two portions. In other words, the risk of a fatal IHD for someone eating five portions of fruit and vegetables a day would be 4% lower compared to someone consuming four portions a day, and so on up to eight portions or more."

Ischaemic heart disease (IHD) is characterised by reduced blood supply to the heart; people suffering from it can develop angina, chest pains and have a heart attack.

The EPIC study started in 1992 and recruited participants from a total of ten European countries* until 2000. For the analysis of IHD deaths, data from eight countries for people aged between 40 and 85 were used. Participants answered questions about their diet at the time of entry to the study and other questions about health, socio-economic status and life-style, such as smoking, drinking and exercise habits. They were followed-up for an average of nearly eight and a half years.

The researchers found that the average intake of fruit and vegetables was five portions a day; people in Greece, Italy and Spain ate more, and those in Sweden ate less.

When analysing the data, the researchers made allowances for confounding factors such as differences in lifestyles and eating habits. However, the study could be limited by errors in measuring correctly people's fruit and vegetable intake as well as other aspects of their diet. In addition, the study had a higher proportion of women, which might not be generalisable to the wider European population.

Dr Crowe said: "The main message from this analysis is that, in this study, people who consume more fruits and vegetables have lower risk of dying from IHD. However, we need to be cautious in our interpretation of the results because we are unsure whether the association between fruit and vegetable intake and risk of IHD is due to some other component of diet or lifestyle.

"If we could understand, by means of well-designed intervention studies, the biological mechanisms that could underlie the association between fruits and vegetables and IHD, this might help to determine whether or not the relation between fruit and vegetables with IHD risk is causal."

In an accompanying editorial, Professor Sir Michael Marmot, director of the University College London (UCL) International Institute for Society and Health, head of the UCL Department of Epidemiology and Public Health, and chairman of the Commission on Social Determinants of Health, writes that it is difficult to reach firm conclusions about causation from results that show a 22% lower risk of dying from IHD (an odds ration of 0.78) in people who eat eight portions of fruit and vegetables a day.

He continues: "Such an odds ratio is, however, of huge practical importance. Cardiovascular disease is the most common cause of death. A reduction of 22% is huge. But... this reduction in mortality comes with consumption of eight portions a day, or 640g. Such a high consumption was found in only 18% of the men and women in these eight cohorts. There would need to be big shift in dietary patterns to achieve this healthy consumption of eight portions a day. It is worth trying to move in that direction. Reductions in cancers of several sites, in blood pressure and stroke, would add to this reduction in fatal CHD. Moving to a diet that emphasises fruit and vegetables is of great importance to public health."

*The ten countries include: Denmark, France, Germany, Greece, Italy, The Netherlands, Norway, Spain, Sweden and the United Kingdom. For the Heart component of the study, data from France and Norway were excluded due to the small number of IHD deaths at the end of the follow-up period.