Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Bergner, B.
Statins
A critical assessment of the effects and the effectiveness of one of the most prescribed drugs
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2023. pp. 129
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Heinemann Akos
- Lippe Irmgard Theresia
- Altmetrics:
- Abstract:
- Statins are one of the most prescribed drugs worldwide. Many people have the condition of too high lipid levels followed by atherosclerotic cardiovascular disease which could end up in a fatal or non-fatal major cardiovascular event. Statins can reduce the level of LDL-C by inhibiting a key enzyme in the production of cholesterol. Less cholesterol is produced more LDL-cholesterol is cleared out of the blood. The less LDL-C is in blood the less onset or progression of an atherosclerotic cardiovascular disease there is. There is evidence that a high level of LDL-C increases the risk of getting an ASCVD event independent of other occurring risk factors. Some uncertainties occur with the prescription of statins. The most important question is what benefit there is with statins. How many cardiovascular events and more importantly how many cardiovascular deaths can be prevented with this therapy. Because of studies that had shown no survival advantage in older patients with low cholesterol this risk factor seems to be more important in the middle aged. Furthermore, the questions arise as to whether they should be prescribed for primary or secondary prevention and what needs to be considered in older patients. Primary prevention with statins is not recommended generally. Only people at very high risk, with diabetes or familial hypercholesterinemia are supposed to be treated. Clear target values are defined in the guidelines and if these are not achieved, the statin should either be up titrated or the lipid-lowering therapy should be extended. There are different potent lipid-lowering therapies. Statins vary in the extent to which they lower LDL levels, other lipid-lowering medications may be prescribed, or may be combined with statins. Failure to respond to therapy may be due to genetics or compliance. On the other hand, the question should be asked if an intensive therapy is necessary. There is no greater benefit in total mortality with a more intensive lipid-lowering therapy like a statin plus ezetimibe or PCSK9 inhibitor compared to a less intensive lipid lowering therapy, where the rate of non-fatal cardiovascular events did decrease further with an intensive lipid lowering therapy. The European guideline recommends liberal use of statins as secondary prevention because of the increased risk of recurrence. Concerns occurred when an increase in hemorrhagic strokes were seen, but the detected rates were very low and some trials did not find an association between statins and an increased incidence of hemorrhagic strokes. Statins are widely used as secondary prevention in older patients. To prevent drug-drug interactions, pravastatin is mostly recommended in the elderly. Gender medicine is finding its way more and more into clinical practice and the difference between men and women must be considered when talking about cardiovascular risk. Women who smoke and women with diabetes have a higher relative risk of a cardiovascular disease compared to men, but there are other risk factors for women that needs to be considered like preeclampsia, gestational diabetes, polycystic ovary syndrome, early menopause, and autoimmune diseases. Common and important comorbidities that are related to the cardiovascular system, like diabetes, HIV, chronic kidney disease or heart failure must be considered and statins should be used appropriately in these patients. Possible side effects that can occur when taking statins are very important, how they can be avoided and what about the risk of harm compared to the benefit. Muscle symptoms are the most common adverse events. They can be very harmless, but in rare cases rhabdomyolysis with kidney failure can occur. New onset diabetes can be caused by statins, as well as the onset of cataracts. Familial hypercholesterolemia as a genetic disease in which the heterozygous form is inherited in an autosomal dominant manner and the more severe homozygous form is inherited recessive also plays an im