The treatment of hypercholesterolemia has undergone a revolution during the past 12 years with the availability of potent, safe HMG-CoA reductase inhibitors, a

& u also known as statins. Lovastatin, pravastatin, fluvastatin, simvastatin, atorva-statin, and cerivastatin are available drugs in this category in the United States. They inhibit HMG-CoA reductase, the rate-limiting enzyme in cholesterol synthesis. This results in both decreased hepatic production of apo B-containing lipoproteins and upregulation of LDL receptors. The combination of these effects, fewer apoprotein B lipoproteins entering the blood stream, and more efficient removal of those lipoproteins back into the liver have the overall effect of dramatically lowering plasma levels of LDL cholesterol. VLDL triglyceride concentrations are also reduced in many subjects with moderate hypertriglyceridemia. Triglyceride reductions are directly related to both the initial triglyceride level and the reduction of LDL cholesterol achieved. The most potent statins (simvastatin and atorvastatin), at the highest doses, can lower LDL cholesterol by up to 45 to 55%, and decrease triglycerides 20 to 45%. Reductase inhibitors can raise HDL cholesterol by up to 10%, but should not be considered as first-line agents in individuals with very low HDL levels.

The statins are very safe and effective medications. The main side effect associated with statin therapy is a myositis, characterized by diffuse, severe muscle tenderness and weakness, and elevated levels of CPK (usually greater than 10 times the upper limit of normal). In severe cases, rhabdomyolysis and concomitant myoglobinemia can place patients at risk for renal failure due to myoglobin-uria. This is particularly a risk in diabetics who have preexisting proteinurea. However, the incidence of myositis when statins are used as monotherapy is only about 1 in 500 patients. If the patient receives careful instructions about the signs and symptoms, with advice to stop the medication and consume large volumes of liquids, serious outcomes should be avoidable. Statins can also cause non-clinically significant elevations in liver function tests in 1 to 2% of patients, and only at the higher doses of each agent. The statins do not appear to have any effects on diabetic control. Most importantly, results from several clinical trials have demonstrated reductions in CHD events and deaths in type 2 diabetic patients treated with statins. Therefore, the statins are the first-line therapeutic agents for diabetic patients with isolated high levels of LDL cholesterol, with combined hyperlipidemia, or with moderate hypertriglyceridemia and an LDL cholesterol level above NCEP goal. Statins can also be used in conjunction with other hypolipidemic agents under some circumstances.

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

Get My Free Ebook

Post a comment