Statin Statinsdrugs are used to lower cholesterol in the body, actually body needs somecholesterol to work.
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If cholesterol level increases in blood it stick to thewalls of arteries and makes narrow or even block them. Bydiet and exercise if cholesterol levelsdid not reduce, then it will be necessaryto take medicine. Often, this medicine is a statin. Statins they lower LDL(bad)cholesterol levels and raise HDL (good) cholesterol levels. This willmake slow the formation of plaques in arteries. Statinsare safe for most people. But these medicines are not recommended for pregnantpatients and patients with chronic liver disease.
They can also cause seriousmuscle problems. Some statins interact adversely with other drugs. This may causefewer side effects. Statins – the good, the bad and the controversyStatins – the goodIf cholesterol levels are high in the body it causes coronaryartery disease due to this fatty deposits build up in the walls of arteries whichsupplying blood to the heart. Often thesedeposits can harden and form plaques.
Plaques are at risk of rupture, Due to thisundersurface of the artery lining is exposed, provoking an injury response. Inthis instance the blood flow through the artery can be blocked by the clotformation. By this starving of muscle occurs due to no supply of oxygen toheart muscles then heart attack occurs. Because of this atherosclerosis processdescribed above, is predominantly a silent process with no symptoms.
Althoughtreatment for heart attacks has improved greatly over the years, a third ofheart attack patients still die within 28 days, with the majority of thesedeaths occurring in the first 24 hours. Statins has two main mechanisms of action. First they stabilise plaques, by making them lesslikely to rupture and therefore reducing the heart attacks. Second, they reducethe levels of cholesterol in the blood by inhibiting the enzyme in theliver that produces it. So less cholesterol level in the blood stream meansthat there will be less deposition of plaques in walls of the artery.
There aretwo types of cholesterol: HDL, is the “ good”, cholesterol type; and LDL, the “ bad” cholesterol type or disease-causing type. Cholesterol is measured in unitscalled mmol/L, and a large meta-analysis was conducted in 20121 and concluded that for every 1 mmol/Ldrop in LDL (the “ bad”) cholesterol, there was a reduction of 24% in the riskof heart attack, 15% in the risk of stroke, and 19% in the risk of deathfrom coronary artery disease. The average patient on an appropriate statinat the correct dose might therefore expect their future cardiovascularrisk to be halved. Statins the badAlldrugs have some benefits and some side effects. The most popular side-effectassociated with statins is muscle pain, it is due to particular concern about alink between statins and a potentially fatal muscle condition calledrhabdomyolysis. Many papers have examined the prevalence of this and have foundit to be 1 in 10, 000-100, 000 In2014 review of statin studies were conducted in 83000 people and concluded thatstatin side effects such as muscle aches nausea, insomnia occurred in placebotaking patients and not in the statin taking patients. Statinscan, however, be incriminated in two areas: first statin drugs are given to the 3% of patientsthey experienced there is a rise inliver enzymes, and second statin drugs given to patients they experienced risein diabetes, comparing to those taking placebo (2.
4%)2. In asymptomaticpatients it is unclear, whether the rise in liver enzymes is harmful, but manypeople naturally raised liver enzymes as a result of obesity or alcohol intakein any case, and in many cases the findings are dose-dependent such as loweringthe statin dose results in normalisation of the liver enzymes. In diabetes the study were found that only 1 in 5new diagnoses of diabetes could be directly related to statin.
However diabetesitself is a major risk factor for cardiovascular disease. The controversyIn2014 the UK’s healthcare watchdog, NICE, issued guidance suggesting that thethreshold for offering a statin to an individual should be reduced from a 20%risk of a cardiovascular event in the next 10 years to 10%. The percentage riskis calculated by using a tool called the QRISK2, it takes into account manyfactors including age, blood pressure, smoking status and cholesterol. Statins has proved benefit in high-riskpatients who have coronary artery disease, but for low risk patients concernwas raised that in side-effects and in healthy people into “ patients” outweighed the potential benefit. In 2012 report found that “ reduction of LDLcholesterol with statin therapy significantly reduced the risk of major vascularevents in individuals with 5-year risk lower than 10% even in those with noprevious history of vascular disease. Somany controversies also created over statins and their link. And suggested thatmemory loss confusion, and dementia are possible consequences of statin therapybut reports have been very variable, making it difficult for a true conclusionto be drawn.
However in 2000 twostudies reported a lower risk ofdementia in those using statins, but subsequent reports published mixedresults, including favourable, unfavourable and neutral findings. More recently (20134) a systematic reviewand meta-analysis of the short and long-term cognitive effects of statins wasundertaken, and found that short-termuse of statins don’t have any significanteffect in terms of confusion or memory loss. Furthermore long-term studies, encompassing 23, 443 patients with an average exposure to statin therapy from 3to 24. 9 years, found no association between statin use and increased risk ofdementia. 5 trials even found a favourable effect, and pooling the trialresults revealed a 29% reduction in the risk of dementia in statin-treatedpatients.
References1 Theeffects of lowering LDL cholesterol with statin therapy in people at low riskof vascular disease: meta-analysis of individual data from 27 randomisedtrials. CholesterolTreatment Trialists’ (CTT) Collaborators. Lancet.
2012 Aug 11; 380(9841): 581-590 2 What proportion ofsymptomatic side-effects in patients taking statins are genuinely caused by thedrug? Systematic review of randomized placebo-controlled trials to aidindividual patient choice. Finegold JA, Manisty CH, Goldacre B, Barron A, Francis D. EuropeanJournal of Preventive Cardiology.
2014, Vol 21(4) 464-474 3 Statins in the treatmentof dyslipidaemia in the presence of elevated liver aminotransferase levels: atherapeutic dilemma. Calderon R, Cubeddu L, Goldberg R, Schiff E. Mayo Clin Proc. 2010 Apr; 85(4): 349-356 4Statins and cognition: a systematic reviewand meta-analysis of short and long-term cognitive effects. Swiger KJ et al. MayoClin Proc 2013 Nov; 88(11): 1213-21 Side effects of statin use and focus onrhabdomyolysis. ESC Council for Cardiology Practice.
Vol 12, no 28-29 July 2014