Statins for Lowering Cholesterol Level – Using Rationally!

Statins for Lowering Cholesterol Level – Using Rationally!

(Dr. Guru Prasad Mohanta, Professor, Department of Pharmacy, Annamalai University,

Annamalai Nagar – 608 002, Tamil Nadu, E. mail: gpmohanta@hotmail.com)

           

Statins are one of the most prescribed medicines and have been used as weapon for preventing cardiovascular events like heart attacks, strokes etc. The evidence shows that they are effective in reducing the cardiovascular events in persons who are at risk or who have had events earlier but have no benefits (in terms of preventing cardiovascular events) in persons who are at low or no risk. Unfortunately while recommending the use of statins, this aspect is not looked into, but just the elevated cholesterol level. They lower the synthesis of cholesterol. There are several statins currently is use: atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin.

The elevated cholesterol level has been viewed as devil and after a laboratory investigation the focus is on reducing the cholesterol level rather than looking the person holistically. It is recommended that total cholesterol should be brought down to below 200 mg/dL and low density lipoprotein (LDL) cholesterol under 100 mg/dL. High cholesterol leads to hardened arteries that can cause heart attack or stroke. But the cholesterol has many vital functions too. The cell membrane is made up of cholesterol. It helps digestion by being part of bile acid production in liver. It is essential for formation of steroids, myelin sheath etc. which are essential for many bodily functions. Everyone needs little bit of cholesterol to work properly. The high density lipoprotein (HDL) is a good cholesterol and at 60 mg/dL or above helps protecting against heart diseases.

Like other medicines, the statins too have their share of concern. They are reported to cause several adverse effects like muscle pain, fatigue, severe life threatening muscle destruction leading to kidney failure (rhabdomyolysis), high blood sugar, liver dysfunction and cognitive impairment. Earlier the country’s drug regulatory authority, Drug Controller General, India, has issued instruction to mention the adverse effects that are associated with the use of statins. It is also recommended to have liver function tests prior to recommending statins and thereafter as required. The USFDA removed the warning of the need of routine periodic monitoring of liver enzymes. The routine periodic monitoring of liver enzymes does not found to be effective detecting or preventing serious liver injury.

The life style modification has been proved to be effective in lowering the high cholesterol level in many occasions. Exercises, eating low fat diet, and eating vegetable proteins lower elevated cholesterol and LDL level. Too low fat diet is also not advisable. These non-pharmacological strategies need to be exploited before using statins for controlling elevated cholesterol especially for primary prevention of cardiovascular diseases. However, life-long dietary habits are difficult to change. On the other hand, the statins have proven evidence of preventing the cardiovascular events in persons who are at risk or have a history of events. A judicious use would help the patients and avoid unnecessary exposure to the harmful effects.