Sunday, 21 April 2013

Cholesterol levels and CIS conversion

Raised cholesterol levels are associated with MS disease activity. #MSBlog #MSResearch

Epub: Weinstock-Guttman et al. Lipid profiles are associated with lesion formation over 24 months in interferon-β treated patients following the first demyelinating event. J Neurol Neurosurg Psychiatry. 2013 Apr 17.

OBJECTIVES: To investigate the associations of serum lipid profile with disease progression in high-risk clinically isolated syndromes (CIS) after the first demyelinating event.

METHODS: High density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) were obtained in pretreatment serum from 135 high risk CISers (≥2 brain MRI lesions and ≥2 oligoclonal bands) enrolled in the Observational Study of Early Interferon β-1a Treatment in High Risk Subjects after CIS study (SET study), which prospectively evaluated the effect of intramuscular interferon β-1a treatment following the first demyelinating event. Thyroid stimulating hormone, free thyroxine, 25-hydroxy vitamin D3, active smoking status and body mass index were also obtained. Clinical and MRI assessments were obtained within 4 months of the initial demyelinating event and at 6, 12 and 24 months.

RESULTS: The time to first relapse and number of relapses were not associated with any of the lipid profile variables. Higher LDL-C (p=0.006) and TC (p=0.001) levels were associated with increased cumulative number of new T2 lesions over 2 years. Higher free thyroxine levels were associated with lower cumulative number of contrast-enhancing lesions (p=0.008). Higher TC was associated as a trend with lower baseline whole brain volume (p=0.020). Higher high density lipoprotein was associated with higher deseasonalised 1,25-dihydroxy vitamin D3 (p=0.003) levels and a trend was found for deseasonalised 25-hydroxy vitamin D3 (p=0.014).

CONCLUSIONS: In early multiple sclerosis, lipid profile variables particularly LDL-C and TC levels are associated with inflammatory MRI activity measures.


"This study confirms what has been seen in established MS; i.e. raised cholesterol levels are associated with more active and severe disease. This may help explain why MS seems to respond to statins; statins are drugs that lower cholesterol. The question is how do statins work in MS? Do they work independently of their cholesterol lower effects? Is the degree of cholesterol lowering related to their impact on MS disease activity or brain atrophy? All this could be addressed in the next simvastatin trial; that is if and when the next statin trial gets done. Without a new statin with a long patent life we are unlikely to see trials done by pharma. Can we as academics do the next trial? Yes, we can but we will need a lot of support from the funding agencies to a trial that is large enough to get a drug licensed. We are trying to motivate Dr Chataway to apply for funding for the next study. Can you help us to help him to get his pen out?"

7 comments:

  1. There has been a mentioning this week of high cholesterol = artherosclerosis and plaque formation in Alzheimer's. A paper from Stanford I believe. This would point more towards atrophy than acute lesions...

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  2. One "side effect" of statins is increased 25(OH)D and 1,25(OH)D. Some think it is this increase in vitamin d not the reduced cholesterol that reduces heart disease, by reducing inflammation. One day we will find out who is correct, probably when statins are no longer covered by patents.

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  3. Isn't Cholestersol a preliminary stage od Cortisol and therefor needed in some way?

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  4. What can we do to 'nudge' Dr Chataway to get the trial/funding applications underway?

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  5. Doesn't the statins / low cholesterol theory fit with Swank's work, in which he seemingly halted disease progression by putting patients on a v low sat fat diet over a long period? Wouldn't this approach have exactly the same cholesterol reducing effect that statins have?

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  6. Ever thought about changing your diet and lifestyle to lower cholesterol rather than statins?

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  7. On Gilenya 2years now.Get full bloods done every three months. April 2016 Cholestrol 5.9, July 6.4, October 5.6. Had bloods due & done Jan and cholesterol now 5.1. Achieved lowering level by improving diet & exercise,walking outside. Next bloods due April hopefully down again maybe 4.5 or 4.4. No statins try diet and exercise.

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