Gene mutations linked to inherited Parkinson’s disease also appear to be connected to the more common form of the disease that strikes people whose relatives don’t have it, researchers now say.

In the study, an international team of researchers confirmed that mutations in the alpha-synuclein gene and microtubule associated protein tau boost the risk of developing Parkinson’s disease.

Parkinson’s, a neurological disorder, affects about 1.5 million Americans and disrupts the body’s ability to move properly.

“With this better understanding of the underlying genetic variants involved in the progress of this disorder, we have more insight into the causes and underlying biology of this disease,” Andrew B. Singleton, chief of the neurogenetics laboratory at the U.S. National Institute on Aging and co-leader of the study, said in a news release from the agency. “We hope this new understanding will one day provide us with strategies to delay, or even prevent, the development of Parkinson’s disease.”

Dr. Richard J. Hodes, director of the institute, said in the news release that the findings “support the notion that the sporadic and rare familial forms of the disease are related and that common genetic variability plays a role in developing the disorder.”

A new study raises more questions about ezetimibe (Zetia), a drug used by millions of Americans in tandem with statins to lower LDL, or “bad,” cholesterol.

The trial, known as ARBITER-6 HALTS, was stopped early in June after it was discovered that LDL-cholesterol-lowering Zetia was less effective than extended-release niacin (Niaspan), which raises HDL, or “good,” cholesterol levels, in reducing plaque build-up in the arteries.

Clinical trials are generally terminated early if a safety issue arises, less so when a measure of success is achieved.

The niacin combination also reduced the number of heart attacks and deaths.

“This trial provides a clear and undeniable statement on the superior clinical effectiveness of niacin over ezetimibe,” study principal investigator Dr. Allen Taylor, director of Advanced Cardiovascular Imaging and the Lipid/Prevention Clinic at Washington Hospital Center in Washington, D.C., said at a Sunday afternoon news conference.

The study was funded by the pharmaceutical company Abbott Laboratories, which makes Niaspan, and Taylor and other study authors have received consulting fees from the company. Merck & Co. makes Zetia.

Taylor presented the findings at the American Heart Association’s annual meeting in Orlando, Fla. The report was also released early online Nov. 16 in the New England Journal of Medicine.

“This trial showed the clear superiority of niacin over ezetimibe. I would say that the combination of LDL-lowering and HDL-increasing with niacin was associated with a greater regression of atherosclerosis,” added Dr. John J.P. Kastelein, author of one of two editorials accompanying the paper. Kastelein is with the department of vascular medicine, Academic Medical Center, Meibergdreef, the Netherlands.

The current evidence on Zetia and a related drug, Vytorin, both made by Merck, have not been overwhelmingly positive. One study found that the combination of Vytorin and a statin was no better than the statin on its own.

Although statins — drugs such as Crestor, Lipitor and Zocor — reduce LDL cholesterol levels in a great many patients, some people need additional therapy. The ARBITER-6 HALTS study looked at either raising HDL levels (Niaspan) or further lowering LDL levels (Zetia).

The study enrolled 363 patients with or at high risk for heart disease, but was stopped after only 208 participants had finished the full 14 months.

Patients taking extended-release niacin, to boost HDL levels, in addition to a statin had less plaque build-up and fewer cardiovascular “events,” such as heart attacks, compared to patients taking the combination drug Zetia, which delivers both a statin and ezetimibe, both of them dampening LDL levels.

Participants taking Zetia had more plaque build-up in their carotid artery.

In an accompanying editorial in the journal, researchers at Johns Hopkins University said the study findings were too preliminary to warrant any changes in how doctors treat high-risk patients.

Merck stood by its product. “The results of the small ARBITER 6 study do not, in any way, change our view of Zetia and Vytorin as effective medicines for fighting LDL cholesterol,” said Peter S. Kim, president of Merck Research Laboratories. “Nothing from this study … changes the well-established understanding that lowering LDL cholesterol is the primary target of therapy according to the guidelines. Zetia and Vytorin, when used as a supplement to a healthy diet, are effective in reducing LDL cholesterol.”

And American Heart Association spokesman Dr. Robert Eckel recommended waiting for safety results from a larger ongoing trial involving Zetia, while emphasizing that there is no clear reason to stop using Zetia.

“I would caution the public and prescribing community about reaching conclusions too early,” he said. “At this point, there is no evidence that the drug does harm. I see no reason at this point to be concerned about using ezetimibe as an LDL-lowering therapy as an option for patients who need a further decision made about their treatment.”

Taylor said over-the-counter niacin, a B vitamin, “is not considered a useful alternative to prescription niacin. Its safety and efficacy are unknown.”

Men, especially black men, are at a relatively high risk of sudden cardiac death over their lifetime compared to women, a new study finds.

That lifetime risk in men aged 40 and over is one in eight, or 12.3 percent — triple that of women, whose risk is one in 24, or just over 4 percent, the study found.

“Compare this with the lifetime risk for lung cancer, which is one in 12 for men and one in 16 for colon cancer, and one in 17 for both in women,” said Dr. Donald Lloyd-Jones, lead author of the study presented Sunday at the annual meeting of the American Heart Association, in Orlando, Fla. “These are diseases we think heavily about the consequences and certainly screen people.”

“Relatively high lifetime risk estimates for such a devastating disease hopefully have implications for people thinking about prevention efforts,” added Lloyd-Jones, who is associate professor of medicine and preventive medicine at the Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University in Chicago.

“These are startling figures,” said Dr. Elliott Antman, spokesman for the American Heart Association (AHA), and professor of medicine at Harvard Medical School and director of the Coronary Care Unit at Brigham and Women’s Hospital, both in Boston.

Traditionally, estimates have focused on a person’s risk of sudden cardiac death over the next 10 years. These new numbers are the first lifetime estimates for sudden cardiac death, Lloyd- Jones said.

According to the American Heart Association, some 300,000 cardiac arrests — when the heart suddenly loses function, often without prior diagnosis of heart disease — occur each year in the United States.

The study authors looked at sudden cardiac death data on nearly 5,000 U.S. adults involved in three major heart studies, following them from age 40 through age 95.

African-American men had roughly twice the risk as white men at any given age, while black and white women had roughly the same risk all the way through.

The risk for sudden cardiac death actually went down for both genders as age went up, the research team noted. That’s because “we’ve depleted some of those individuals who were going to have an event at younger age, but at [age] 80 many things are competing to kill us so at that point sudden death is less likely to be a cause of death,” Lloyd-Jones said.

Having traditional risk factors for heart disease — such as high blood pressure, high cholesterol, diabetes, lack of physical activity and smoking cigarettes — also upped the risk of sudden cardiac death substantially, the study found.

“If you reach the age of 50 with all optimal risk factors, essentially no one went on to experience sudden death in their remaining life span, whereas those with two or more major risk factors had much higher rates comparatively,” Lloyd-Jones said.

The good news is that the same treatment and prevention strategies already advocated for reducing the risk of heart disease should cover both bases.

“Lowering the risk of heart attack also lowers the risk of dying suddenly,” Antman said. “It helps you.”

Certain drugs can also help ease heart risks, but two studies released Sunday at the AHA meeting found that a promising anti-clotting medication in development, cangrelor, was no better than the standard blood thinner clopidogrel (Plavix) for patients undergoing angioplasty. The study was also published online Sunday in the New England Journal of Medicine.

The two phase III trials took place at more than 200 sites in 18 countries and involved over 14,000 patients. In the larger of the two studies, involving nearly 9,000 patients, researchers found no significant difference in terms of death, heart attack or the need to re-open a vessel when patients received cangrelor just prior to angioplasty/stenting, followed by post-angioplasty Plavix, versus using Plavix (pre- and post-angioplasty) alone.

Heart attack patients in need of emergency procedures were less likely to suffer further serious cardiovascular events, including death, when given AstraZeneca’s experimental Brilinta blood clot preventer than those who used Plavix, according to a study presented on Sunday.

Importantly, the Brilinta patients also were found to be at no greater risk for major bleeding than those taking Plavix — an encouraging sign for such drugs that work by preventing blood cells called platelets from clumping together.

The lack of increased bleeding risk seen with AstraZeneca’s new medicine could provide comfort that safety was not compromised in order to obtain its greater ability to prevent cardiovascular death, heart attack and stroke for up to a year.

The findings are an important new slice of data from a more than 18,000-patient comparative international trial called PLATO unveiled earlier this year in which Brilinta also proved superior to Plavix, one of the world’s most widely used medicines sold by Bristol-Myers Squibb and Sanofi-Aventis with annual sales of some $9 billion.

Analysts see Brilinta as a potential multibillion-dollar a year seller for AstraZeneca, which plans to file an application seeking U.S. approval later this year.

For the latest data, researchers focused on the 8,430 sickest patients in the PLATO trial — those in the midst of so called ST-elevation heart attacks with total obstruction of at least one coronary artery who were in need of emergency angioplasty and stents to restore blood flow and save heart muscle.

“The results are very clear and actually very consistent with the overall trial results of the larger PLATO trial,” preventing cardiovascular events while not increasing the major bleeding risk, said Dr. Philippe Gabriel Steg, lead investigator of the study that was presented at the American Heart Association scientific meeting in Orlando.

Steg said Brilinta, known chemically as ticagrelor, works much more quickly than Plavix, which could be an advantage in these patients in whom time to performing an artery clearing procedure is crucial.

“Clopidogrel’s drawbacks include slower onset of effectiveness, which is not suited to the need for rapid effect in STEMI (ST-elevation heart attacks),” Steg said, using the chemical name for Plavix.

DEATH REDUCTION

According to the latest findings, 9.3 percent of patients receiving Brilinta suffered cardiovascular death, heart attack or stroke for up to a year, compared with 11 percent in the Plavix group, a statistically significant difference, researchers said.

There was an 18 percent relative reduction in death from any cause at one year in the Brilinta group, they said.

“This sets apart this drug and this study from all other oral agents studied so far,” Steg said.

“In previous trials, other oral agents prevented cardiovascular events, but did not significantly reduce mortality,” added Steg, who said the Astra drug could become “a standard of care” for managing very high risk patients undergoing angioplasty procedures.

He said the survival benefit suggests Brilinta may be protecting patients through mechanisms that are not yet known.

For these sickest heart patients in the study, the benefits seen with Brilinta increased over time, researchers said.

Another advantage demonstrated by Brilinta that could help once it begins competing with one of the world’s top-selling medicines is how quickly its effects wear off.

Researchers said once the medicines are stopped, normal platelet clotting ability returns in fewer days than with the Astra drug, which could provide a real clinical difference in patients in need of more serious invasive procedures in which bleeding is a serious risk.

However, there are a couple of issues potentially standing in Brilinta’s path to swift approval.

As seen in previous Brilinta studies, there was a higher incidence of breathlessness — 12.9 percent versus 8.3 percent with Plavix — that could be a signal of unintended impact on lung function. Steg said that side effect was mild and went away after a few days after the start of treatment.

There also was an as-yet-unexplained lack of benefit over Plavix seen in North American patients, who accounted for about 9 percent of total PLATO subjects but who would represent the most important market for the drug’s future success.

There has been speculation that higher doses of aspirin being taken by U.S. patients in the study could account for the disparity, or that it was merely a statistical fluke.

But it is likely something the U.S. Food and Drug Administration will look at very carefully before making any approval decisions.