Statins in the Prevention of Cardiovascular Diseases: Facts and Prejudices.

Abstract

SAŽETAK: Unatoč brojnim dokazima o neposrednoj učinkovitosti statina u snizivanju ukupnog i LDL kolesterola te dugoročnih učinaka u primarnoj i sekundarnoj prevenciji srčanožilnih bolesti, još uvijek se u svakodnevnoj praksi susrećemo s različitim predrasudama vezanima za neželjene učinke liječe-nja i eventualnu štetnost statina ne samo bolesnika nego i nekih liječnika. Osnovni mehanizam djelovanja statina inhibicija je enzima hidroksi-metil-glutaril koenzima A reduktaze (HMG CoA), enzima koji je ključan u sintezi kolesterola. Drugi potencijalni mehanizmi njihove učinkovitosti jesu stabilizacija aterosklerotskoga plaka, smanjenje endotelne disfunkcije, upalnih te protrombotskih intravaskularnih procesa. Nuspojave liječenja statinima većinom su blage s učestalošću na razini placeba i najčešće ne zahtijevaju prekid liječenja. Treba istaknuti da uvijek treba poticati bolesnike na aktivni, nesedentarni način života, odnosno redovitu tjelesnu aktivnost, zbog njezinih jasnih pozitivnih uči-naka u prevenciji te u liječenju dislipidemije i srčanožilnih bolesti. SUMMARY:In spite of ample evidence supporting the direct effectiveness of statins in the reduction of total and low-density lipoprotein (LDL) cholesterol and long-term effects in primary and secondary prevention of cardiovascular diseases, in everyday practice we are still faced with various prejudices against the undesired effects of treatment and the possible adverse effects of statins, not only among patients, but among some physicians as well. The basic mechanism of action of statins is inhibiting 3-hydroxymethyl-3-methylglutaryl coenzyme A reductase (HMG-CoA), a key enzyme in cholesterol synthesis. Their other potential mechanisms are stabilization of atherosclerotic plaque and reduction of endothelial dysfunction, as well as inflammatory and post-thrombotic intravascular processes. The side effects of treatment with statins are generally mild, with a frequency comparable to placebo, and usually do not require the termination of treatment. It is necessary to emphasize that patients must always be encouraged to adopt an active, non-sedentary lifestyle that includes regular physical activity, due to its clear positive effects in the prevention and treatment of dyslipidemia and cardiovascular diseases.KLJUČNE RIJEČI: statini, dislipidemija, kardiovaskularna prevencija.