Statins are the reference treatment for treating hypercholesterolemia and reducing the risk of occurrence of a cardiovascular event. Alternatives are offered for patients who cannot tolerate them. We take stock with doctors François Paillard, cardiologist, and Amine Morjane, general practitioner.
Definition: what is a statin?
“Statins are the class of most commonly prescribed drugs for hypercholesterolemiaexplains Dr François Paillard, cardiologist. They aim to reduce cholesterol synthesis by the organism. They strongly lower cholesterol levels and significantly reduce cardiovascular complications.“. People who take statins should be checked regular medical supervision by the prescribing physician (general practitioner, cardiologist, angiologist, neurologist, etc.). “A first blood test is established 3 months after the start of treatment. Depending on the results, it is possibly adapted or modified by the doctor.“. Then a blood test is performed every 6 to 12 months to check the effectiveness of the treatment. Consumed”by 220 million patients worldwide“, statins are among the drugs the most prescribed in the world.
What are the indications for statins?
Statins are indicated exclusively in the treatment of hypercholesterolemia. “It should be noted, however, that in certain circumstances, particularly when the arteries are diseasedfor example in case of infarction or arteritis of the lower limbsstatins can be indicated to lower cholesterol even if it is normal at the start“, continues the cardiologist. “It is then necessary to lower cholesterol well below normal values to limit the risk of progression of arterial disease.“.
What drugs are in the statin family?
“All drug names in this class (at least in their generic form) end with “…statin“, completes Dr. Paillard: fluvastatin, pravastatin, simvastatin, atorvastatin, rosuvastatin…“. Note that all statins have a generic form.
What are the side effects of statins?
Watch out for grapefruit juice
“The main adverse side effects of statins are muscle problems which occur in 5-9% of patients“, answers the specialist. It can be cramps, excessive body achesmore rarely decline in muscle strength. “The majority of patients (more than 90%) therefore tolerate statins perfectly well, but given the very large number of prescriptions (several million in France), patients with adverse effects are also quite numerous…“. Adverse effects considered to be serious are very rare (1 case in 100,000) and occur especially at high doses: significant increase in liver enzymes (transaminases), severe muscle damage (rhabdomyolysis or autoimmune necrotizing myositis).
► Beware of grapefruit juice (juice and fruit) which interacts with two statins: simvastatin and atorvastatin. Its consumption exposes you to a risk of overdose and an increase in the adverse effects of these two substances.
What are the contraindications of statins?
“The contraindications of statins are:
- Mainly muscle problems already present in the patient, such as myopathies;
- Exceptionally some liver disease“, recalls Dr. Paillard.
What are the alternatives to statins?
There are several solutions when the patient cannot tolerate statins.
► The lipid-lowering of the fibrate family. “They lower LDL cholesterol levels, but also partly blood levels of triglycerides and uric acidexplains Dr. Amine Morjane, General Practitioner. They are used when the statins had no effect or caused side effects troublesome“People taking fibrates should be under regular medical supervision.”The doctor prescribes an initial assessment after two to three months of treatment and possibly modifies it when reading the results. He can decide to have a blood test done every two to three months for a year to check the effectiveness and tolerance of the treatment.“. The undesirable effects observed may vary depending on the substance: Difficult digestion, nausea or diarrhea, itching, hives, photosensitivity, dizziness or tiredness. Gallstones have also been reported.
► “In case of intolerance (especially muscular) to statins, the main drug proposed is ezetimibe which acts by a different mechanism (blocker of cholesterol absorption at the intestinal level)“, continues the cardiologist. It can sometimes give muscular problems but much more rarely. “Another drug that also acts at the intestinal level and does not cause muscle problems is QUESTRAN (colestyramine). On the other hand, it quite often causes digestive problems.“.
► The Lomitapid is used, in combination with other lipid-lowering drugs, especially in adults with homozygous familial hypercholesterolemia. “Homozygous familial hypercholesterolemia is a genetic diseasesays Dr. Morjane. If possible, it should be confirmed by a test before starting treatment.“. The most common side effects of Lomitapide are digestive: diarrhea (79%), nausea (65%), difficult digestion (38%), vomiting (34%), abdominal discomfort (20%) and increased liver enzymes (transaminases).
Regular physical activity can increase HDL cholesterol levels
► “Omega-3 polyunsaturated fatty acids are sometimes prescribed for patients who have high blood triglyceride levels, as an addition to the dietcontinues the general practitioner. These fatty acids inhibit the formation of LDL cholesterol“. Their main adverse effect is a prolongation of blood clotting time.
► “Some very powerful new drugs, administered only by injection, PCSK9 inhibitorsdo not cause muscle problems, recognizes Dr. Paillard. But they can currently only be prescribed in patients who have presented cardiovascular complications such as infarction or stroke or arteritis.“.
Finally, “engage in regular physical activity helps increase HDL cholesterol levels, decrease LDL cholesterol levels and triglyceride levelsconcludes Dr. Morjane. Regular athletes have a “good” cholesterol level up to 30% higher than sedentary people…”.
Thank you to doctors François Paillard, cardiologist at the University Hospital of Rennes and 1st Vice-President of the French Federation of Cardiology, and Amine Morjane, general practitioner, university internship supervisor and director of the medical center of COSEM.
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