cholesterol

Statins

Statins (pravastatin, atorvastatin, cerivastatin, fluvastatin) are among the most effective drugs for reducing total cholesterol and LDL. As mentioned several times in the numerous articles dedicated to cholesterol, the concentration of this lipid in the blood is heavily influenced by its endogenous synthesis (80%), while the contribution of the diet is altogether modest (20%).

The common supplements used to lower plasma cholesterol levels (plant sterols, chitosan, glucomannan, etc.), are based on the simple reduction of its absorption. Statins act instead at the origin of the problem, limiting the synthesis of endogenous cholesterol. In particular, these drugs block the activity of an enzyme called HMG-CoA reductase

(Hidrossi-Methyl-Glutaril-Coenzyme A-reductase), fundamental in the processes of cholesterol synthesis especially in the liver.

Another big advantage of statins lies in their selectivity, that is in the ability to reduce above all the synthesis of "bad" cholesterol (LDL), leaving the "good" (HDL) almost unchanged.

The statins are also equipped with interesting anti-inflammatory properties, which protect the vessel walls, stabilizing the atheromatous plaque and reducing the risk of adverse events such as heart attack, angina pectoris and sudden rupture of an aneurysm.

Statins reduce total cholesterol in a dose-dependent manner (on average 30-40%), acting above all on LDL cholesterol (reduction from 20-25% to 50-60%) and to a lesser extent on VLDL; the plasma triglycerides are also significantly reduced (-10%), while the HDL cholesterol remains unchanged or even tends to increase (+ 10%).

Appreciable results are already registered after a couple of weeks from the beginning of the treatment and reach their peak after 30-40 days.

Statins and side effects

Despite their enormous therapeutic efficacy, statins are not without side effects that mainly affect the liver. Changes in liver function and muscle pain are among the most common side effects. For this reason the use of statins is contraindicated in alcoholics, pregnant women, nursing mothers, children and patients with liver dysfunctions. They should also not be associated with fibrates, lipid-lowering drugs useful for lowering blood triglyceride levels due to the risk of myopathy, rhabdomyolysis and kidney failure. Even major physical efforts can increase the risk of muscle damage.

The association with ion exchange resins is instead positive and can reduce LDL cholesterol even by 50-60%, without compromising the level of HDL.

Although statins are generally well tolerated, it is a good rule to periodically monitor the levels of transaminases in the blood, as an indication of possible liver problems.

Gastrointestinal disorders (flatulence, diarrhea, acid regurgitation, nausea and constipation) may appear at the beginning of therapy, but tend to regress spontaneously.

Despite this, statins are the reference drug in the treatment of familial hypercholesterolemia, a disorder linked to hereditary factors and characterized by an endogenous synthesis of cholesterol higher than normal. In these cases, diet therapy, combined with lifestyle correction, can provide poorly appreciable results, making it necessary to resort to specific drugs.

Statins are also used in cases of unfamiliar hypercholesterolemia or mixed hyperlipidemia. Their preventive effectiveness is out of the question but in this regard there is no lack of controversy over the risk of using it with too much. Before using drugs to lower one's cholesterol levels it is in fact essential to take alternative routes, such as dietary control and other non-pharmacological treatments (increased physical activity and reduced body weight).