Study confirms statins are saving lives

A study of more than 500 000 patients with atherosclerotic cardiovascular disease (ASCVD) conducted by US scientists suggests that statins are saving lives, and that patients on the highest doses of the drugs are the least likely to die. Researchers from Stanford University found an inverse association between intensity of statin therapy and mortality, with patients who received high-intensity statins having the greatest reductions in risk of death, according to a study published online by JAMA Cardiology. The researchers examined 1-year cardiovascular mortality by intensity of statin therapy among patients aged 21–84 years with ASCVD treated in the Department of Veterans Affairs health care system. Intensity of statin therapy was defined by the 2013 American College of Cardiology and American Heart Association guidelines, and use was defined as a filled prescription in the prior 6 months. The study sample included 509 766 eligible adults with ASCVD at study entry (average age, 69 years), including 30% receiving high-intensity statin therapy (defined as atorvastatin, 40–80 mg; rosuvastatin, 20–40 mg; simvastatin, 80 mg), 46% receiving moderate-intensity statin therapy (atorvastatin, 10–20 mg; fluvastatin, 40 mg twice a day or 80 mg once a day [extended-release formulation]; lovastatin, 40 mg; pitavastatin, 2–4 mg; pravastatin, 40–80 mg; rosuvastatin, 5–10 mg; and simvastatin, 20–40 mg), 6.7% receiving low-intensity statin therapy (fluvastatin, 20–40 mg; lovastatin, 20 mg; simvastatin, 10 mg; pitavastatin, 1 mg; and pravastatin, 10–20 mg), and 18% receiving no statins. During an average follow-up of 492 days, there was a graded association between intensity of statin therapy and mortality, with 1-year mortality rates of 4% for those receiving high-intensity statin therapy, 4.8% for those receiving moderate-intensity statin therapy, 5.7% for those receiving low-intensity statin therapy, and 6.6% for those receiving no statin. The researchers also found that the maximal doses of high-intensity statins (atorvastatin, 80 mg and rosuvastatin, 40 mg) conferred the greatest survival advantage compared with submaximal doses of high-intensity statins. The benefits of high-intensity statins were consistent for those older than 75 years compared with younger patients.

Knowing risk factors may predict melanomas

Researchers from the University of Sydney have pinpointed a set of risk factors that could help doctors tailor individual skin examinations and catch melanoma at an early stage. The study, published online by JAMA Dermatology shows that the team has identified high risk patients who may benefit from tailored surveillance. The authors examined clinical features associated with melanomas according to patient risk factors (many moles, history of previous melanoma and family history of melanoma) to improve the identification and treatment of those at higher risk. The study included 2727 patients with melanoma from the Melanoma Patterns of Care Study, of whom 1052 (39%) were defined as higher risk because of family history, multiple primary melanomas or many moles. The most common risk factor in this group was having many moles, followed by a personal history and a family history. The authors report the average age at diagnosis was younger for higher risk patients (62 v 65 years) compared with those patients at lower risk because they did not have these risk factors. However, that age differed by risk factor: 56 years for patients with a family history, 59 years for those with many moles and 69 years for those with a previous melanoma. Higher risk patients with many moles were more likely to have melanoma on the trunk, those with a family history were more likely to have melanomas on the limbs, and those with a personal history were more likely to have melanoma on the head and neck. Reported limitations of the study include risk factors based on physician recall and patient medical records. The authors also did not assess the reliability or validity of the risk factor data. “The results of our study suggest that a person’s risk factor status might be used to tailor their surveillance program in terms of starting age and education about skin self-examination or more intensive surveillance,” the study concludes.

Implant gets paralysed monkeys walking

A device that restores movement of a paralysed leg in monkeys as early as 6 days after spinal cord injury is reported in an article published in Nature. The implantable, wireless brain–spine interface uses components that have been approved for research in humans, and is now one step closer to entering clinical trials to test the efficacy of this approach in people with paraplegia. Previous studies have shown that it is possible to use signals decoded from brain areas involved in planning and executing movement to control movement of a robotic or prosthetic hand and, in one case, the patient’s own paralysed hand. However, whether this approach can be used to restore the complex leg muscle activation patterns and coordination involved in walking has not previously been investigated. The authors, from the Swiss Federal Institute of Technology, developed a brain–spine interface that decodes signals from the part of the motor cortex that orchestrates leg movements to stimulate electrodes implanted in “hotspots” in the lower spinal cord that modulate the flexion and extension of the leg muscles, thus, bypassing the lesion and restoring communication between the brain and the affected region of the spinal cord. The authors tested the interface in two rhesus monkeys, each having one leg paralysed by a partial spinal cord lesion. One of the monkeys regained some use of its paralysed leg within the first week after injury, without training, both on a treadmill and on the ground; the other monkey took 2 weeks to recover to the same point. An accompanying editorial suggested that, given the rapid translation of other neural interfaces from monkeys to humans in recent years, “it is not unreasonable to speculate that we could see the first clinical demonstrations of interfaces between the brain and spinal cord by the end of the decade”.

Young Florey Medal for vaccine delivery system

Professor Mark Kendall, from the University of Queensland, has won the $25 000 CSL Young Florey Medal for his vaccine delivery system, which may replace the syringe. Professor Kendall, from the Australian Institute for Bioengineering and Nanotechnology, has developed the Nanopatch technology, which delivers vaccines directly to the immune-rich cells of the skin epidermis and upper dermis with an array of thousands of microprojections on a single patch – a small square of silicon with 20 000 microscopic spikes. “With vaccines dry-coated to the patch, this eliminates the need for vaccine cold chain and removes the need for electricity networks which are so often unreliable in developing countries.” Professor Kendall has shown that the Nanopatch generates “equivalent and protective immune responses as the traditional needle, but only needs to deliver a small fraction of the dose (eg, 1/100th), making the patch significantly cheaper and easy to apply”. Human clinical trials are underway in Brisbane, and the WHO is planning a polio vaccine trial in Cuba in 2017. The Young Florey Medal was presented to Professor Kendall at the Great Hall in Parliament House, Canberra, on 9 November 2016.

 

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