Content

Introduction

Introduction

Statins are a group of drugs used to lower blood fat levels, i.e. cholesterol and triglycerides.

As for cholesterol, about 80% of blood cholesterol is produced by the body, while only 20% depends on diet. Statins block an enzyme (hydroxy-methylglutaryl-coenzyme A reductase) which is essential for the process of production of cholesterol by the body, thus reducing the levels of LDL cholesterol (from the English Low Density Lipoprotein, low density lipoprotein). The intake of statins can reduce the total cholesterol value by 30-40%, represented by the sum of LDL and HDL (from the English High Density Lipoproteins, high density lipoprotein) acting on the quantity of LDL cholesterol with a decrease of even 50-60%, while the levels of HDL cholesterol remain unchanged or may even increase.

The common supplements used to lower cholesterol levels in the blood, such as, for example, plant sterols, act by limiting the absorption of cholesterol from food and, therefore, can only act on the amount of cholesterol that depends on the diet.

Statins also act on blood triglyceride levels, with a more modest effect than cholesterol, reducing them by about 10%.

Statins have anti-inflammatory properties that can protect artery walls, thus reducing the risk of cardiovascular events such as heart attack, angina and stroke. The effectiveness of statins is out of the question but, often, they are used too lightly. To lower blood cholesterol levels it is important to contact your doctor who will be able to recommend a lifestyle more suitable for achieving this goal, suggesting a diet healthy, regular exercise and weight loss if you are overweight. If your lifestyle change is not enough to reduce your blood cholesterol levels, your doctor will decide whether or not to prescribe the drug and in which modality.

When to take statins

When to take statins

Statins are taken in case of hypercholesterolemia (high levels of cholesterol in the blood), even of a familial type (familial hypercholesterolemia, an inherited disease caused by a "genetic alteration that causes LDL cholesterol in the blood to rise).

Statins are also recommended for people who have cardiovascular disease or who have a medium or high risk of developing cardiovascular disease in the next 10 years.

Cardiovascular diseases

High blood cholesterol levels represent a risk factor for developing cardiovascular diseases, ie diseases that affect the heart and / or the entire blood vessel system of the body. The main types of cardiovascular disease include:

  • coronary heart disease, caused by the hardening and narrowing of the coronary arteries due to the accumulation of fat (atherosclerosis) with consequent reduction, or total blockage, of the blood supply to the heart. The consequences can be angina pectoris (chest pain), myocardial infarction or even the "cardiocirculatory arrest. Coronary heart disease is the most common form of heart disease
  • stroke and transient ischemic attack (TIA), due to reduced or blocked blood flow to the brain following a sudden closure or rupture of a brain vessel
  • peripheral vascular disease, characterized by reduced blood circulation in the arteries of the limbs (upper and lower) caused by atherosclerosis. This disease mainly affects the lower limbs, i.e. the legs

Statins cannot cure these diseases but they can help prevent them from occurring or getting worse. Usually, statins are used in conjunction with lifestyle changes:

  • adoption of a "power supply healthy, low in saturated fats (fats with a chemical structure characterized by simple bonds, mainly contained in foods of animal origin such as, for example, butter, lard, lard and sausages)
  • regular practice of moderate physical activity
  • cessation of smoking
  • moderate alcohol consumption

People at risk of cardiovascular disease

Statins may be recommended for people who, even in the absence of cardiovascular disease, have a high risk of developing it over the next ten years or when lifestyle changes have not reduced their risk level. Several parameters can influence the level of cardiovascular risk:

  • age
  • gender
  • ethnic group (some populations have a higher risk of developing cardiovascular disease)
  • weight and height
  • smoking habit, or having been a smoker in the past
  • family members with cardiovascular disease
  • hypertension (high pressure)
  • hypercholesterolemia
  • chronic diseases (diabetes, rheumatoid arthritis, chronic kidney disease, atrial fibrillation)
How to take statins

How to take statins

Statins come in tablet form to be taken once a day, at the same time each day, usually in the evening before bedtime. It may happen that you forget to take the drug at the usual time: in this case just take the tablet again the following day at the same time. If, on the other hand, you take more tablets by mistake, therefore, a higher dose than the usual contact your doctor or pharmacist for advice or you should go to a hospital.

In most cases, statin therapy should be continued for the rest of life. In fact, if you stop, your cholesterol returns to high levels within a few weeks.

Warnings and contraindications to the use of statins

Warnings and contraindications to the use of statins

The use of statins is contraindicated in people with severe liver disease, or if a liver problem is suspected due to abnormal blood tests. Generally, before prescribing statins, doctors evaluate the results of blood tests to check the state of health of the liver and indicates the checks to be performed three and twelve months after the start of therapy.

Pregnancy and breastfeeding

The use of statins is contraindicated during pregnancy and breastfeeding because no reliable data are available on their safety. If you have an unscheduled pregnancy while taking statins, you should contact your doctor for advice on controlling cholesterol during gestation.

People with an increased risk of side effects

Statins should be taken with caution by all people who have a higher risk of developing side effects such as myopathy (muscle disease) or rhabdomyolysis (breakdown of muscle fibers). Factors that may increase the risk of developing side effects when taking statins are:

  • age over 70 years
  • liver disease
  • excessive alcohol consumption
  • previous side effects affecting the muscles, after taking statins or fibrates, another type of medication used to lower blood cholesterol
  • cases of myopathy or rhabdomyolysis in the family

In all these cases, frequent checks are required to check for possible complications or a lower dosage of statins may be recommended.

Interactions with other drugs

Interaction with other drugs is one of the most critical aspects of statin therapy. People taking statins often also take other drugs that can change the effect or safety of statins, for example by reducing their effectiveness or increasing their effectiveness. possibility of developing side effects, such as myopathy Drugs that can interact with some types of statins are:

  • some antibiotics and antifungals
  • some drugs for the treatment of HIV
  • warfarin, medicine commonly used to reduce blood clotting
  • cyclosporine, drug that suppresses the immune system and is used to treat many types of diseases such as psoriasis and rheumatoid arthritis
  • danazol, synthetic hormone used for the treatment of certain diseases such as endometriosis
  • verapamil and diltiazem, drugs known as calcium channel blockers, used to treat cardiovascular disease
  • amiodarone, an antiarrhythmic medicine used to correct some specific changes in the heart rhythm
  • bundles, drugs that, like statins, lower blood cholesterol levels

It is important to know that if you also need to take one of these drugs during statin therapy, your doctor may prescribe an alternative medicine to the statins or may lower your dosage. In some cases, your doctor may recommend that you temporarily stop taking statins.

Food and alcohol

Grapefruit juice can interact with some statins and increase the risk of developing side effects. Your doctor may advise you to avoid its use or to consume it in limited quantities. Alcohol, if consumed in large quantities, can increase the risk of side effects while, if taken in moderate quantities, it does not seem to interact with the effect. pharmacological of statins.

Information about the drug

For complete details on the precautions to use and on possible interactions with other medicines, it is advisable to read the package leaflet included in the package of the drug. If in doubt, always contact your doctor or pharmacist.

(Unwanted) side effects of statins

(Unwanted) side effects of statins

Statins can cause side effects. Before starting to take statins, however, the doctor will inform the patient about the risk-benefit ratio of using the drug. Generally, they are well tolerated by most people but in case some of the side effects are thought to be too much troublesome, your doctor may propose to change the dose or change the type of statin.

Common (unwanted) side effects

Although side effects can vary from person to person and depending on the type of statin used, the most common ones include:

  • nosebleed (epistaxis)
  • burning throat
  • runny or stuffy nose (non-allergic rhinitis)
  • headache
  • general malaise
  • gastrointestinal disorders, such as diarrhea, flatulence, constipation, digestive difficulties
  • muscle and joint pain
  • hyperglycemia
  • increased risk of diabetes

Side effects on the muscles

Occasionally, statins can cause inflammation and damage to the muscles. If you experience muscle pain, sensitivity and weakness that cannot be explained by having performed an intense physical effort, it is necessary to speak to your doctor immediately. In this case it may be necessary to measure the level in the blood of the creatine kinase (CK), a substance released into the blood by inflamed or damaged muscles. If CK levels are five times higher than normal, the doctor may indicate temporarily stopping the statins and prescribe a lower dosage once CK values ​​return to normal.

For further and more detailed information on the possible side effects of statins it is advisable to consult the package leaflet.

Alternatives to statins

Alternatives to statins

If a person has cholesterol levels that are too high, the doctor might suggest making lifestyle changes to reduce the amount of cholesterol, before prescribing statins. The changes include:

  • adoption of a healthy and balanced diet
  • practice of regular physical activity
  • maintaining optimal body weight
  • moderate alcohol consumption
  • cessation of smoking

If the lifestyle change isn't enough to lower blood cholesterol levels, your doctor may prescribe statins.

Types of statins

Types of statins

The molecules belonging to the group of statins currently in use in Italy are:

  • atorvastatin
  • fluvastatin
  • lovastatin
  • pravastatin
  • rosuvastatin
  • simvastatin
Bibliography

Bibliography

NHS. Statins (English)

MedlinePlus. Statins (English)

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