Low-risk people benefit from heart drugs

People at low risk of a heart attack could still benefit from taking cholesterol-lowering drugs, researchers say.

Half of all heart attacks occur in patients with a low cardiovascular risk, and a large study has shown the risk of these events is reduced when patients take drugs to lower cholesterol, University of Sydney researchers say. The researchers, from the National Health and Medical Research Council (NHMRC) at the university, have questioned whether Australian guidelines should be changed to allow more people access to cholesterol-lowering drugs. NHMRC deputy director Anthony Keech and research fellow Jordan Fulcher said the safest option to lower bad cholesterol levels was to eat well, exercise and lose weight if necessary. But there was also a role for cholesterol drugs, they wrote in the Medical Journal of Australia on Monday. However, expanding the use of the drugs to low-risk people could come at a significant cost.

The two main cholesterol drugs were in the top three most dispensed Pharmaceutical Benefits Scheme (PBS) medications in the 2010/11 financial year, the article said. Drugs targeting cholesterol were the most costly class of medication in the PBS. But the authors said there was now evidence that cholesterol-lowering drugs could help treat people at low risk of heart disease. ‘This new evidence must be urgently considered, with appropriate economic analyses, for incorporation into clinical and PBS guidelines,’ they wrote. The Heart Foundation’s clinical issues director, Dr Robert Grenfell, said more work was needed to reduce people’s heart attack risk by encouraging exercise and diet changes before giving them a pill in the absence of disease. ‘We’d be telling people who aren’t sick to take a pill for something they haven’t got,’ Dr Grenfell told AAP. ‘Active lifestyle and a healthy diet are the first steps. ‘All these things need to be done before we consider that a pill is the answer to this.’ Dr Grenfell said further research and an analysis of the cost and the benefits to patients were needed before cholesterol drugs were recommended to low-risk people.

Chemotherapy can boost cancer – study

Cancer-busting chemotherapy can cause damage to healthy cells that triggers them to secrete a protein that sustains tumour growth and resistance to further treatment, a study says. Researchers in the US made the ‘completely unexpected’ finding while seeking to explain why cancer cells are so resilient inside the human body when they are easy to kill in the lab. They tested the effects of a type of chemotherapy on tissue collected from men with prostate cancer, and found ‘evidence of DNA damage’ in healthy cells after treatment, the scientists wrote in Nature Medicine. Chemotherapy works by inhibiting reproduction of fast-dividing cells such as those found in tumours.

The scientists found that healthy cells damaged by chemotherapy secreted more of a protein called WNT16B, which boosts cancer cell survival. ‘The increase in WNT16B was completely unexpected,’ study co-author Peter Nelson of the Fred Hutchinson Cancer Research Center in Seattle told AFP. The protein was taken up by tumour cells neighbouring the damaged cells. ‘WNT16B, when secreted, would interact with nearby tumour cells and cause them to grow, invade, and importantly, resist subsequent therapy,’ said Nelson.

In cancer treatment, tumours often respond well initially, followed by rapid regrowth and then resistance to further chemotherapy. Rates of tumour cell reproduction have been shown to accelerate between treatments. ‘Our results indicate that damage responses in benign cells… may directly contribute to enhanced tumour growth kinetics,’ wrote the team. The researchers said they confirmed their findings with breast and ovarian cancer tumours.

The result paves the way for research into new, improved treatment, said Nelson. ‘For example, an antibody to WNT16B, given with chemotherapy, may improve responses (kill more tumour cells),’ he said in an email exchange. ‘Alternatively, it may be possible to use smaller, less toxic doses of therapy.’