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Frequent questions | |
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ESTATINAS TO LOWER THE CHOLESTEROL | |
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 DEFINITION INDICATIONS EFFECTS CHARACTERISTICS METABOLISM TO CONSULT |
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The estatinas are a group of medicines that inhibit the enzyme HMG CoA reductasa (hidroximetilglutaril CoA reductasa). The members of this group are the following agents: lovastatina, pravastatina, simvastatina, fluvastatina, atorvastatina, and cerivastatina. The employment of the estatinas for the control of the dislipidemias, has been constituted in one of the props of the treatment of the cardiovascular diseases that take an injury as a substratum ateroesclerótica. Clinical essays carried out in thousands of patients have demonstrated the aptitude of these medicines to reduce significantly the mortality, if they are used by time prolonged in patients with cardiopatía coronary previous. Also they have demonstrated his efficacy in the primary prevention, on having diminished the incidence of the first cardiovascular event, Act especially in diminishing the values in blood of the cholesterol LDL (20-60 %), but also they have a modest effect on the cholesterol HDL increasing it in approximately 5 % and diminishing the concentrations of triglicéridos (TGL) in average of 20 %. The first inhibitor of the HMG-CoA reductasa used in patients with dislipidemia was the lovastatina, isolated compound of cultivation of aspergillus. By means of light structural modifications the pravastatina and the simvastatina were obtained. Simvastatina and lovastatina they are profármacos, while pravastatina it is administered in his active form. The Fluvastatina, and the Atorvastatina, there are synthetic compounds administered in his active form. From the introduction of the lovastatina, more than 10 years ago, it is known that this group of medicines can produce asymptomatic elevation of the levels of the enzyme creatinfosfoquinasa in the plasma, myalgias, miositis and, rarely, rabdomiolisis. The latter picture is characterized by a destruction of the miocitos demonstrated for mioglobinemia and mioglobinuria, associated with an elevation of the CK at least 10 times on the top normal limit. The consequences are hiperkalemia, hiperuricemia, metabolic acidosis, miocardiopatía, respiratory and renal insufficiency, which can lead to the death. Another alteration that happens with the estatinas is the elevation of the hepatic transaminasas séricas, which can reach up to three times the recognized limit like normal without the suspension of the therapy being necessary. In these cases the periodic measurement of these advises itself enzymes, and the suspension of the therapy if the aminotranferasas exceed this level. In the thousands of patients incorporated into the wide clinical essays who evaluated the efficacy and safety of the estatinas, the percentage of patients who suspended the treatment for adverse effects was similar between the agreements with estatinas or placebo. The rabdomiolisis, the adverse effect of major gravity for his potential deadliness, was described in only one patient treated with simvastatina in the study. The muscular poisonous effect of the estatinas is a dependent dose, as it is demonstrated when there increases the incidence of this adverse effect on having associated estatinas with inhibiting of the system microsomal hepatic citocromo P450. Between the medicines that inhibit the isoenzima CYP3A4 they are ketoconazol, itraconazol, ciclosporina, eritromicina, claritromicina, verapamil and diltiazem. The estatinas are the prop of the treatment of the dislipidemias and ateroesclerótica improve the prognosis of the vascular illness. The balance risk - benefit favors extensively to these medicines, but we must be attentive when the patient communicates to us muscular weakness or myalgias, which can be the initial declaration of the miotoxicidad. /
The most frequent side effects in the treatment with estatinas are:
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