News in brief - Oct. 17, 2005

Statin advantage and LDL - Getting HIV treatment right early - Increase in research dollars may not be well spent

Statin advantage and LDL

The greater the reduction in LDL cholesterol from the use of statin drugs, the greater the reduction in incidence of major coronary events, coronary revascularization and stroke, according to a met-analysis published Sept. 26 in The Lancet.

The meta-analysis combined data from 14 randomized trials of statins involving more than 90,000 patients.

The investigators, from England and Australia, found that statin therapy could reduce the 5-year incidence of major coronary events and stroke by about one-fifth per mmol/L reduction in LDL cholesterol irrespective of a person's pre-treatment cholesterol level or other characteristics.

Meanwhile, another study found that statin use was associated with a 36% reduction in the risk of fracture among elderly men. Previous studies have shown an association between statin use and fracture risk in women but, the researchers noted, since many statin users are elderly men with heart disease, these findings are particularly relevant. The study appeared in the Sept. 26 Archives of Internal Medicine.

Getting HIV treatment right early

Testing for drug resistance in HIV-infected patients at the time of diagnosis is cost-effective and may increase patients' life expectancy, according to a study in the Nov. 1 Clinical Infectious Diseases, now available online.

Resistance to antiretroviral therapy, even in patients who have never received treatment, is a growing concern. But testing for the presence of resistant genes is not standard procedure, probably because of its high cost and unproven benefit, researchers note.

This cost-effectiveness analysis, however, indicated that performing the resistance testing before treatment is begun can effectively guide a physician's choice of regimen and increase a patient's survival by more than 14 months compared with no resistance testing.

An accompanying editorial said the study provides sufficient evidence to recommend genotypic resistance testing in all drug-naïve patients at the time of diagnosis. But the authors cautioned that not all resistant mutations can be detected by standard tests.

Increase in research dollars may not be well spent

Funding for medical research has increased significantly, but this is not necessarily translating to medical advances, according to a study in the Sept. 7 issue of the Journal of the American Medical Association.

Researchers compiled data from various levels of government as well as foundations, charities, universities and private industry. Biomedical research funding from all sources increased from $37.1 billion in 1994 to $94.3 billion in 2003. When adjusted for inflation, this meant that the amount of money spent doubled. Dollars from private and public sources increased at the same rate.

Authors praised the increase in funding for medical research but questioned how the money was being spent. For example, 5.6% of the United States' total health expenditures are for biomedical research, but only 0.1% is for health services research. The money spent also led to a significant increase in the production of new medical devices but not quite as many new pharmaceuticals.

"The low proportion of spending on health services research is especially notable, since it is the main tool available to evaluate the clinical benefit of technology," wrote the authors.