Cholesterol is an essential molecule for the life of the human being, since it fulfills vital functions. For example, it is a precursor for the synthesis of sex hormones and bile acids, and is part of multiple structures in the body.
This molecule can have two origins:
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Exogenous: Ingested from the diet and absorbed in the small intestine. Contrary to what was believed, it has been shown that it does not greatly affect blood cholesterol levels.
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Endogenous: synthesized by the body, in the liver. It depends on various genetic and dietary factors. Simple sugars and saturated fat increase endogenous cholesterol synthesis.
Cholesterol concentrations that are excessively high -or too low- can trigger health problems. Hypercholesterolemia is associated with an increased risk of cardiovascular diseases, .
It is important to distinguish between two types of cholesterol. The LDL, known as “bad”, should not exceed a certain limit since it increases the risk of cardiovascular diseases. The HDL, known as “good”, it is desirable that it be high, .
Currently there are various methods to determine the , which allows estimating the risk of death from this cause. This is very useful in asymptomatic people and is also low cost.
The main methods used to predict the risk of death from a cardiovascular event at 10 years are based on the REGICOR and SCORE tables. The first take into account whether the patient is a smoker, diabetic, age, blood pressure values, total cholesterol, HDL cholesterol, and LDL cholesterol. The latter take into account sex, age, blood pressure, plasma cholesterol concentrations, and whether or not the subject smokes.
In non-diabetic patients both tables provide very similar results. Taking into account the result of this analysis and the presence of other pathologies, it is determined whether or not the patient should receive drug treatment, provided that diet and physical activity are not sufficient or have failed.
What patients can take statins?
Pharmacological treatment to reduce total and LDL cholesterol and, therefore, cardiovascular risk.
Patients who could benefit from its use are as follows.
Individuals whose LDL cholesterol levels exceed 240 mg/dL and patients with values greater than 190 mg/dL with familial dyslipidemia or severe arterial hypertension.
Likewise, the objective is to achieve LDL cholesterol values less than 70 mg/dL in patients with established cardiovascular disease such as ischemic heart disease, with type I diabetes mellitus and damage to a target organ, type II diabetes mellitus with associated cardiovascular risk factors. or target organ injury, with advanced chronic kidney disease, and patients with SCORE levels ? 10%.
Finally, the goal of LDL cholesterol values below 100 mg/dL is established in patients with type I and II diabetes mellitus without lesions of any target organ or associated cardiovascular risk factors, patients with moderate chronic kidney disease and patients with values of SCORE between 5 and 10%.
If the SCORE values are between 1 and 5%, the therapeutic goal is LDL cholesterol levels below 115 mg/dL. This is more necessary the higher the value of SCORE.
Statins inhibit an enzyme involved in hepatic cholesterol synthesis, hydroxymethylglutaryl coenzyme A reductase (HMG-CoA reductase). In other words, they decrease their formation (Figure 1).
As a consequence, a part of the blood cholesterol will need to be used and the LDL cholesterol will decrease between 15 and 50%.
In addition, it has been observed that serum triglycerides decrease slightly and HDL cholesterol increases. The statins available today are: atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin.
Side effects
In general, these are safe and well-tolerated drugs, but some patients suffer from side effects.
Other unwanted effects such as cognitive disturbances and headache may also appear. These are more frequent in people who take other medications simultaneously (corticosteroids, antiretrovirals, opioids), in women, in people over 65 years of age, and in people with other pathologies.
Therefore, it is necessary to take into account the risk-benefit ratio of treatment in each person. The main adverse effects with commonly used therapeutic doses occur at the gastrointestinal level and are nausea, vomiting and dyspepsia (pain or discomfort in the upper abdomen).
The debate on lipid-lowering treatment with statins arose mainly when their use was associated with an increased risk of cancer. However, it is important to point out that many of the results come from studies carried out on animals and that, on the contrary, the clinical trials carried out to date
It is well known that statins increase some enzymes related to liver damage (transaminases). However, the appearance of this negative effect is closely related to the dose used and also .
On the other hand, it is true that these drugs increase the risk of diabetes. Finally, some studies have shown an increase in body weight in these patients. However, this fact may be related to the eating and physical activity habits of each individual. These people, when observing a decrease in their cholesterol level, .
Alternatives to statins
In the event that statins are not enough or cannot be administered, other treatments can be used, combined or not with statins, such as bile acid sequestrants.
These, by forcing the liver to synthesize new bile acids, produce a decrease in plasma cholesterol. However, they present the problem that they are not usually well tolerated and can increase serum triglycerides. Fibrates can also be used, which lower total cholesterol, LDL, and triglycerides in the blood, while increasing HDL levels.
In conclusion, it should be noted that, in order to maintain adequate levels of cholesterol and low cardiovascular risk, it is important to follow appropriate dietary habits, engage in regular physical activity and not smoke.
If necessary and the healthcare professional considers it to be so, the indicated pharmacological treatment should be followed and any adverse effect suffered should be reported.
It’s also important to remember that, like all medications, statins are not without their risks. Unwanted side effects depend on various factors and some of the ones we have heard about in various media and social networks in recent years are not proven or fully justified. Finally, if in doubt, consult your doctor or pharmacist. Below is The Conversation’s page counter tag. Please DO NOT REMOVE. End of code. If you don’t see any code above, please get the new code from the Advanced tab after clicking the republish button. The page counter does not collect any personal data. More information: http://theconversation.com/es/republishing-guidelines
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