Side effects of statins: weighing the pros and cons

Increased blood cholesterol levels are one of the factors leading to the development of heart and vascular diseases. After all, it is this organic substance, present in excessive quantities in the body, that forms atherosclerotic plaques in the capillary cavities, interfering with proper blood flow.

Cholesterol statins are a group of medications designed to treat and prevent many diseases that often accompany high cholesterol. Today we will talk about what statins generally are, how they act on the body, what are the beneficial and harmful properties of these medications.

What are statins and who are they prescribed to?

Before starting a conversation about the benefits and harms of statins, you need to find out what they are and how drugs in this group act on the human body. In the twentieth century, doctors recognized atherosclerosis as a disease that in many cases is the cause of heart attack and stroke.

Before this, for a long time it was mistakenly believed that atherosclerosis develops and progresses due to the natural aging of the body, and this process is irreversible. However, the discovery of statins had a revolutionary effect in medicine. It has been proven that they are indeed capable of lowering blood cholesterol levels.

The mechanism of action of statins will be described in more detail below, but the general principle of action of these drugs is to accelerate and regulate cholesterol, as well as to reduce the concentration of the substance by slowing down HMG-CoA reductase. As a result, the damaged inner vascular layer is improved at that stage of atherosclerosis when it cannot yet be diagnosed, but the accumulation of cholesterol plaques inside the capillaries has already begun.

If statins are taken correctly, following medical instructions and not stopping the drugs without permission, the concentration of low-density lipoproteins (LDL) decreases, the volume of high-density lipoproteins (HDL) increases, and the risk of heart attack and stroke is prevented.

Who should take statins:

• patients diagnosed with hypercholesterolemia of primary and hereditary forms of homozygous and heterozygous pathology;
• people suffering from cardiac ischemia, regardless of whether they have high cholesterol in the blood;
• patients who have had a heart attack, with diagnosed angina pectoris and coronary syndrome;
• for diabetics to monitor total cholesterol levels in the blood plasma;
• hypertensive patients who regularly suffer from pressure surges and are at risk for the development of cardiovascular pathologies;
• patients diagnosed with atherosclerotic changes in capillaries in various organs and systems - with atherosclerosis of the lower extremities, renal arteries, cerebral vessels, carotid artery.

A specialist can recommend statins to a person who does not suffer from heart pathologies, but at the same time has high cholesterol levels. It must be remembered that many medications, including lipid-lowering ones, cause side effects, so they should only be prescribed by a doctor.

How to lower cholesterol without statins?

Minor disruptions in lipid metabolism can be successfully corrected without the use of lipid-lowering drugs.

Principles of proper nutrition

Diet is an important step in treating high cholesterol at home. A healthy diet implies a balanced menu that provides the body with essential vitamins, minerals, and maintains a balance of proteins, fats, and carbohydrates.

Basic principles of a proper diet:

• Fractional meals 5-6 times a day in small portions (100-200 g). It is advisable to create a regime so that no more than 4 hours pass between meals. At the same time, the energy value of the dishes should remain at the level of the body’s daily needs.
• During the second breakfast and afternoon snack, it is advisable to eat fruits and fresh vegetables. Before bed, low-fat fermented milk products.
• Products are boiled, steamed, baked without forming a crispy crust, or stewed.
• Fried, deep-fried, smoked products are excluded. They do not contain vitamins or minerals, but they do contain carcinogens and fats that cause metabolic failures and worsen the condition of blood vessels.
• People with diseases of the cardiovascular system are not recommended to eat pickled, salty, spicy foods. They contain a minimum of useful substances, and a large amount of salt, vinegar, seasonings often leads to increased blood pressure, swelling, increased stress on the heart, and has a bad effect on the entire body.

In addition to following a diet, you need to take care of sufficient water consumption. In addition to tea, juices, compotes, it is advisable to drink 1.5-2 liters of ordinary water per day. You cannot drink the entire amount at once. Drink water between meals or 30-40 minutes before meals. It is very beneficial to start the day by drinking a glass of water on an empty stomach.

For ardent opponents of pills or simply for those for whom they are contraindicated, there are a number of folk remedies that can also help lower cholesterol levels.

7 traditional methods for lowering cholesterol without statins

1. Rowan berries
   have been known for their beneficial properties for a long time. The berries are harvested ripe and well dried so that they can be used to prepare a decoction. To prepare the decoction, take one tablespoon of rowan berries and brew with 1.5 cups of boiling water. Take half a glass three times a day.
2. Another berry also has a positive effect on blood cholesterol levels and is quite common. The fruits and leaves of black currant
   will serve as an excellent base for infusion. An infusion of leaves is prepared as follows: take 2-3 tablespoons of dried blackcurrant leaves and pour two glasses of hot water. Take the infusion divided into three doses during the day.
3. of blackberry leaves
   is prepared using approximately the same method . They are also harvested in the spring during flowering. The infusion is prepared at the rate of 1.5 tablespoons of crushed leaves per glass of water. The finished portion is divided into three doses and consumed before meals.
4. Linden blossom
   is quite common, you can easily find it in a pharmacy or dry it yourself during flowering in June. Inflorescences must be chosen whole, not spoiled. Collect in sunny, dry weather. The infusion is prepared at the rate of 1 teaspoon of linden blossom per glass of boiling water. This drink is quite safe. It should also be consumed three times a day.
5. Rose hip
   - This is a storehouse of vitamins and nutrients. Its fruits are often recommended for various cardiovascular diseases, vitamin deficiency, weak immunity and during colds. The decoction is prepared at the rate of two tablespoons of fruit per glass of boiling water, then you need to boil the decoction for 15-20 minutes, then leave for 4-5 hours (ideally a day). Be sure to strain the broth before use. Rose hips will help cleanse the blood of excess cholesterol and improve the tone of the entire body.

6. Flax seeds
   have long proven their healing power for many diseases. Eating ground or whole seeds in any form convenient for you, one teaspoon per day, will help you cleanse your body of excess cholesterol and keep your gastrointestinal tract in order.
7. Pumpkin
   is also a storehouse of vitamins and will help your body get rid of excess. When in season, pumpkin pulp is a great product to add to your diet. You can bake it, prepare porridges and soups - in any case, pumpkin can not only add variety to your diet, but also enrich the body with a lot of useful substances. Pumpkin seeds can be consumed all year round. They, like flax seeds, perfectly cleanse the body and help fight excess cholesterol.

Approach your problem without fear. Consult your doctor and go for it. In any case, changing your diet for the better, adding light physical activity and quitting smoking will make your life much brighter.

Mechanism of action

How do statins help lower blood cholesterol? 80% of this organic substance is produced by the human liver from the component mevalonic acid. In order for this acid to be intensively produced, an enzyme called HMG-CoA reductase is required.

It is precisely to reduce its production that the action of statins is aimed. The more the production of the enzyme and, as a result, mevalonic acid decreases, the lower the cholesterol level will be. In such a situation, the only source of organic matter is food, if your own cholesterol ceases to be produced.

Having lost the ability to produce cholesterol, the liver seizes the opportunity to obtain it through other methods. For example, it increases the uptake of cholesterol from the blood, where it ends up after being taken in with food. To achieve this, the synthesis of receptors sensitive to “bad” cholesterol increases. The liver produces a large amount of fats, which are excreted in bile, and these functions require enormous resources from the organ.

Instead of removing toxins and harmful substances from the body, the liver has to constantly replenish cholesterol reserves, as a result of which the concentration of the compound in the blood decreases. According to statin manufacturers, such processes stop the growth of atherosclerotic plaques and serve to prevent the formation of blood clots in capillaries.

General information

Cholesterol is a fatty alcohol, an organic compound found in the cell membranes of living organisms.
Two concepts are often used - cholesterol and cholesterol . What is the difference between them? In fact, this is the name of the same substance, only in the medical literature the term “cholesterol” is used, since the ending “-ol” indicates its relationship to alcohols. This substance is responsible for giving strength to cell membranes .

Sources of cholesterol

But if the level of cholesterol in the body is elevated, cholesterol plaques form in the walls of blood vessels, which, when cracked, create a favorable environment for the formation of blood clots . Plaques narrow the lumen of the vessel.

Therefore, after a cholesterol test, the doctor, if necessary, decides what to do if you have high cholesterol. If the interpretation of the cholesterol test indicates high levels, the specialist often prescribes expensive medications - statins , which are designed to prevent diseases of the cardiovascular system. It is important that the doctor explains that after prescription, the patient needs to take such tablets constantly, as the instructions for use suggest.

But anti-cholesterol drugs have certain side effects, which doctors should warn patients about, explaining how to take the pills correctly.

Therefore, every person who has elevated cholesterol levels must decide whether to take such medications.

There are two main groups of cholesterol medications currently offered: statins and fibrates . In addition, experts recommend that patients consume Lipoic acid and Omega 3 . The drugs used to lower cholesterol are described below. However, their use is advisable only after examination and prescription by a doctor.

Beneficial features

It is impossible to do without prescribing statins for some conditions, often life-threatening. The drugs help not only in treatment, but also in the prevention of various pathologies that often accompany high cholesterol levels. The pleiotropic effects of statins represent an effect on several targets at once, triggering different biochemical processes in the body.

Doctors identify the following pleiotropic properties of lipid-lowering drugs:

• are an addition to diet and a healthy lifestyle in patients with severe heart and vascular diseases;
• help to recover after a heart attack - during this period, elevated cholesterol levels are most dangerous, and statins prevent the re-development of a life-threatening condition for the patient;
• prevent implant rejection and deterioration in the well-being of a patient who has just undergone stenting or coronary bypass surgery by lowering con-cholesterol in the blood;
• serve as a stroke prevention - they help restore normal blood flow after a hemorrhage and prevent the formation of cholesterol plaques in the vessels;
• prevent blockage of blood vessels with severe circulatory disorders in obese people;
• stop progressive atherosclerosis.

With a hereditary form of hypercholesterolemia, many children need to take statins daily. This is necessary to prevent the development of coronary disease. Scientists have found that such a measure can prevent premature death by 93%.

Fibrates: what is it?

Fibrates are also used to lower cholesterol. These drugs are fibric acid . They bind to bile acid, thereby reducing the active production of cholesterol by the liver.

Fenofibrates medicinally lower lipid , which in turn leads to lower cholesterol. According to clinical studies, the use of fenofibrates lowers cholesterol by 25%, triglycerides by 40-50%, and also increases the level of so-called “good” cholesterol by 10-30%.

Instructions for the use of fenofibrates and ciprofibrates indicate that with high cholesterol levels, these drugs reduce the amount of extravascular deposits, and also reduce cholesterol and triglyceride levels in patients with hypercholesterolemia .

List of fenofibrate drugs:

• Thaicolor;
• Lipantil;
• Exlip 200;
• Ciprofibrate Lipanor;
• Gemfibrozil.

But, before you buy and take such medications, you should keep in mind that taking them leads to certain side effects. As a rule, various digestive disorders most often occur: flatulence , dyspepsia , diarrhea , vomiting .

The following side effects have been reported after taking fenofibrates:

• Digestive system: pancreatitis , hepatitis, vomiting, abdominal pain, nausea, diarrhea, flatulence, the appearance of gallstones.
• Musculoskeletal system: muscle weakness, rhabdomyolysis, diffuse myalgia, myositis, spasms.
• Nervous system: headache, sexual dysfunction.
• Heart and blood vessels: pulmonary embolism, venous thromboembolism.
• Allergic manifestations: skin itching and rash, photosensitivity, urticaria .

Combining statins with fibrates is practiced to reduce the dosage and, accordingly, the negative effects of statins.

Harm and side effects

Doctors confirm that with long-term use, non-compliance with instructions and a predisposition to various pathological conditions, statins can indeed cause harm. For this reason, experts first prescribe diet, exercise, and cessation of bad habits to patients with high cholesterol, and, if such measures have no effect, they prescribe lipid-lowering drugs.

The harm of statins to the body has been discussed more and more often lately, and many patients are simply afraid to take drugs in this group, having heard a lot about the large list of side effects

Why are statins dangerous and what negative effects can they have on the human body:

• weakness and pain in muscle tissue - this phenomenon occurs in different degrees of severity. Under the influence of the active substances of statins, muscle fibers age prematurely and stop renewing. As a result, if the specialist does not stop the drug in time, the patient may suffer from partial muscle breakdown, leading to kidney dysfunction and kidney failure (rhabdomyolysis);
• premature death of liver cells - the organ experiences double stress under the influence of statins, and it needs a break of at least 10 days between courses of therapy;
• sleep disturbances and insomnia – drugs from the statin group contain substances that cause nervous overexcitation. In everyday life, a person may simply not notice this, and at night it is difficult for him to sleep. The doctor can adjust the dose of the medicine downwards or at the same time prescribe safe drugs to improve sleep;
• development of obesity - in some cases, with long-term use of statins in the body, metabolic functions are disrupted, which is why a person gains excessive weight;
• overload of the pancreas - with weakness of the organ and constant exposure to statins, some patients develop acute pancreatitis with the formation of foci of necrotization;
• changes in blood sugar levels down and up - manifests itself due to the inability of the pancreas to adequately cope with insulin production. It is produced either too much or less than normal, for this reason it is necessary to constantly monitor sugar levels;
• fragility of bones - many statins promote too rapid removal of cholesterol from the body, as a result of which bone tissue suffers. It becomes thinner, and a new one forms more slowly, the patient is susceptible to injuries and bone fractures;
• decreased immunity - already 4-5 months after starting to use statins, a person begins to suffer more often from viral and bacterial infections due to the defective functioning of immune system cells;
• decreased blood clotting – statins affect the number of platelets in the blood.

In addition to the listed side effects, cases of sexual dysfunction in men and the development of gynecomastia in women have been recorded with long-term use of lipid-lowering drugs.

Due to the effect on cell membranes, the skin becomes dry, and premature wrinkles may appear on the face. Experts also noted cases of the development of cataracts, glaucoma, and kidney inflammation. More often, such side effects are observed in patients over 60–65 years of age, so they need constant medical supervision during statin therapy.

What medications are there?

Drug treatment is necessary primarily for patients at risk (with diagnosed atherosclerosis or a high probability of its development, diabetes). Medicines are also prescribed to people over 50 years of age who suffer from high blood pressure. Here, diet or morning exercises alone are not enough.

The most popular medications are statins. The principle of action is to slow down the formation of cholesterol (inhibit the enzyme HMG-CoA reductase in the liver). Numerous studies have proven their effectiveness and safety.

As for side effects, statins do have them, as do any other medications. For example, muscle pain is one of the possible side effects, an unpleasant symptom, but not life-threatening. According to research, only 5% of cases require adjustment (reduction) of the daily dose of the drug.

Important: when taking statins, you should not get carried away with grapefruit juice, as it increases the concentration of the drug in the blood. You can drink 1 glass a day, no more. You should also tell your doctor about the medications you are taking. While most statins are neutral when interacting with drugs for cardiovascular diseases, taking antifungal drugs, sleeping pills or antibiotics together may cause side effects.

Studies have also confirmed that statins (regardless of the active substance) can increase the concentration of glucose in the blood. Therefore, people with diagnosed (or suspected) diabetes need to undergo additional testing.

Statins are prescription drugs; to achieve a sustainable effect, they are prescribed for a long period of time (the dosage is selected individually), sometimes for life.

Also used for treatment are medications containing active substances that help reduce the absorption of cholesterol from the small intestine. For example, the use of drugs based on ezetimibe reduces the flow of cholesterol into the liver by 54%.

Contraindications to treatment

Like other medicines, statins have contraindications, in the presence of which they should not be taken:

• pregnancy and breastfeeding - the active substances of statins penetrate the placental barrier and can cause congenital malformations and fetal death. There is no specific data on whether the drugs change the composition of mother's milk, so it is better to refrain from using them during lactation;
• severe liver diseases - hepatitis, cirrhosis;
• alcohol abuse;
• special sensitivity to the components of the drug;
• severe dysfunction of the nervous system;
• osteoporosis;
• thyroid diseases;
• high risk of developing myopathy.

At the stage of prescribing statins, it is important what drugs the patient is already taking. The specialist must take into account the cross-interaction of drugs in order to avoid a sharp negative reaction of the body to their simultaneous use.

Generations of statins

What are the types of statin drugs? They are divided into several generations - the very first were isolated from natural components and are called lovastatins. Other drugs are made from synthetic substances, but it is a mistake to believe that drugs based on natural products are safer.

Synthetic drugs are less likely to cause side effects, so it is believed that the most effective and safe statins are those belonging to the second, third and fourth generations. The second generation is represented by fluvastatins. These medications contain sodium salt and are considered effective and safe.

They quickly reduce the concentration of cholesterol in the blood and are prescribed even to children under 18 years of age with a hereditary form of hypercholesterolemia. However, doctors rarely prescribe fluvastatins, preferring more modern drugs of the latest generations. Prominent representatives of fluvastatins are the classic medicine Lescol and the same in an enhanced formula (Forte).

The third generation of statins is the substance atorvastatin, on its basis the original drug of the same name, Atorvastatin, was created. A feature of this group of drugs is considered to improve the activity of the heart and blood vessels while reducing the concentration of cholesterol in the blood. Atorvastatin-based drugs are also prescribed for the prevention of diabetes mellitus, coronary heart disease, heart attack and stroke.

What is the difference between Atorvastatin and Rosuvastatin?

List of statins in this class:

• Atorvastatin,
• Atoris,
• Lipitor,
• Atomax,
• Torvacard,
• Liprimar.

The latest generation of statins are rosuvastatins and pitavastatins. They are the latest pharmaceutical development to lower blood cholesterol levels faster, more effectively and safely. They are prescribed for progressive atherosclerosis, cardiac ischemia, dyslipidemia, and during the rehabilitation period after operations to restore vascular patency.

There is currently only one drug based on pitavastatin. This is Livazo. The following medications contain rosuvastatin:

• Roseart,
• Rosuvastatin,
• Roxera,
• Tevastor,
• Mertenil,
• Akorta,
• Rozulip.

Experienced specialists prefer to prescribe safe drugs from the group of statins to their patients in a minimum therapeutic dose and a long-lasting effect. Such medications include Rosucard, Crestor, Roxera, Akorta, Mertenil and Livazo. They should be taken once a day in the morning or evening, regardless of meals.

Even the best statins have contraindications and side effects, so prescribing them yourself or replacing one drug with another is unacceptable. Many patients who are about to take them are interested in how long to take lipid-lowering drugs.

Each case is individual, the doctor relies on the results of laboratory tests, general health, the presence of concomitant pathologies and many other factors. In many cases, you have to take statins for high cholesterol for life.

Representatives of the statin group

At the same time, it is necessary to take breaks between courses to restore liver tissue. How to use statins correctly, is it possible every other day? Experts recommend taking the prescribed tablets once a day every day, rather than taking a double dose every other day. This reduces the effect of taking the drug and is fraught with the development of side effects.

Statins: list of Russian drugs

Official website of the RLS ® company. encyclopedia of medicines and pharmacy products on the Russian Internet. The directory of medicines Rlsnet.ru provides users with access to instructions, prices and descriptions of medicines, dietary supplements, medical products, medical devices and other goods.

Myths about the drugs of the group

Today, there are many ways to lower cholesterol levels, from following a diet, normalizing your lifestyle, giving up bad habits, to taking various medications. Many drugs are under development, but 99% of doctors' prescriptions come down to statins. What explains this?

The fact is that drugs of the statin group are hypolipidemic, that is, they lower the level of bad cholesterol in the blood and increase the level of good cholesterol. Medicines also prevent complications, reduce the level of vascular inflammation (this is key in the development of atherosclerosis), and reduce the risk of heart attack and stroke.

Statins stabilize atherosclerotic plaques that have already formed in the capillary cavities, which is why the life expectancy of patients who take the drugs as prescribed by a specialist increases. But this particular group of drugs is surrounded by a lot of myths common among people.

We need to figure out whether the rumors about statins are true, based on the opinions of practicing doctors:

• If you constantly use statins, it will no longer be possible to quit them. Indeed, people with elevated levels of lipophilic alcohol in the blood will have to take statins to lower cholesterol constantly. When the drugs are discontinued, especially in patients with a hereditary form of hypercholesterolemia, the indicators return to their original levels. But statins are not addictive in the drug sense.
• In addition to their benefits, statins also cause irreparable harm to health. With the constant use of lipid-lowering drugs, the capillaries are cleared, but the risk of developing cancer, liver and muscle tissue diseases, and diabetes increases. But when prescribing this or that drug, experts weigh the pros and cons. And for one new case of diabetes to occur, 250 patients must be treated over 4 years. Without treatment, 6 patients will simply die from a heart attack. Thus, an increase in the activity of liver transaminases during therapy with standard doses is recorded in two out of a thousand people. Much greater damage to the liver is caused by drinking alcohol and fatty foods.
• Cholesterol drugs do not have a positive effect on the body, they are just a ploy by pharmaceutical companies. Yes, taking statins does not directly affect a person’s well-being. But it is much more effective to take drugs with a long-term effect, which improve the prognosis of survival, rather than giving a momentary insignificant result.

Also, many believe that there are no drugs in medicine that can reduce high cholesterol levels. And to maintain a normal level of lipophilic alcohol in the blood, it is enough to consume certain foods daily.

Of course, proper nutrition is a good help in cleansing blood vessels, but no product or dietary supplement can effectively prevent the progression of atherosclerosis as well as medications prescribed by a doctor. Therefore, if a specialist recommends taking statins, you should not neglect the prescription.

Where is the truth?

How should we feel about the Ohio medical study? Is it revolutionary and does it bring the end of the statin era closer? There are two aspects to this. Firstly, this is not the first, but probably the twentieth publication in serious scientific journals where it is written that statins increase the risk of developing type 2 diabetes. And here the second question arises: why was there not such a loud reaction to previous works? Perhaps because in previous studies the risk of diabetes was not so high and therefore there were fewer complaints about statins. For example, back in 2009, that is, 10 years ago, data from several studies were summarized in which 57.5 thousand patients were observed, and then it turned out that statins increased the risk by 13%. Agree, this is not like in the new study, where the risk increases by 120% (2.2 times). In 2010, the most influential medical journal, The Lancet, published another review on this topic, which included observations of 91 thousand people. Here, statins increased the likelihood of developing diabetes by 9%. The maximum increase in the risk of developing diabetes by 48% was found in only one study in 2012, and this applied only to menopausal women (many diseases occur differently in them). Yes, even in April of this year, an article was published in which the risk of diabetes was even slightly higher than in the study from Ohio. But it was carried out in South Korea, and, according to doctors, the ethnic factor played a role here.

What should patients do in the light of all these studies? There appears to be a link between statins and diabetes, but probably not as strong as the last study (which had a small number of observations). And if the prescription of these medications is mandatory, diabetes prevention measures must be followed (see infographic).

Click to enlarge

How to replace statins

The question of how to replace statins at home in order to minimize the side effects of medications worries many people with high cholesterol. There are natural substances that help reduce this organic substance in the blood:

• ascorbic acid - natural products that contain large quantities of vitamin C include rose hips, currants, sauerkraut, bell peppers, citrus fruits, etc.;
• soy enzymes present in Asian products - tofu, miso, tempeh;
• pectins – present in apples, cabbage, bran, buckwheat and rolled oats, beans, carrots, lentils;
• resveratrol – dark grapes and cranberries;
• polyunsaturated fatty acids – vegetable oils, red fish, caviar, chicken eggs;
• curcumin

The only side effect of this diet is overeating. In everything you need to observe moderation, consuming a variety of foods containing natural statins every day. Garlic also contains them. By regularly eating the root vegetable, the capillaries are cleansed and the level of lipophilic alcohol in the body naturally decreases.

Natural statins

How to choose statins?

Despite all the reviews about statins for lowering cholesterol, the patient must decide whether to take such medications, but this should be done only on the basis of the recommendation of a specialist. What is important, first of all, is not the reviews, but the doctor’s prescription.

If a person nevertheless decides to take statins, then the choice factor should not be the price of the drug, but, first of all, the presence of chronic diseases.

Self-treatment if cholesterol is elevated cannot be carried out with any medications. Treatment for high cholesterol and lipid metabolism disorders is prescribed by a cardiologist or therapist. In this case, the specialist must assess the following risks:

• age;
• floor;
• weight;
• presence of bad habits;
• diseases of the cardiovascular system, other diseases (diabetes, etc.).

It is important to take statins in the dose prescribed by your doctor, and it is important to take a biochemical blood test as often as prescribed by a specialist.

If too expensive pills were prescribed, you can ask the doctor to replace them with drugs that are cheaper. However, it is recommended to use original drugs, since domestically produced generics are of lower quality than the original drug and generics offered by imported manufacturers.

Those who, before taking them, are interested in what the real benefits and harms of statins against cholesterol are, need to consider several important factors in order to minimize the harm of these drugs.

If the medicine is prescribed to elderly patients, it must be taken into account that the risk of myopathy doubles if taken together with medications for hypertension , gout , diabetes .

For chronic liver diseases, it is advisable to take Rosuvastatin in low doses; Pravastatin ( Pravaxol ) can also be used. These drugs provide liver protection, but when using them, you should absolutely not drink alcohol or practice antibiotic .

If there is constant muscle pain or there is a risk of muscle damage, it is also advisable to use Pravastatin, since it is not so toxic to the muscles.

People with chronic kidney disease should not take Fluvastin Lescol , nor should they take Atorvastatin calcium ( Lipitor ), as these medications are toxic to the kidneys.

If a patient seeks to lower low-density cholesterol, it is recommended to use different types of statins.

Currently, there is no clear evidence that it is advisable to take a combination of statins plus nicotinic acid. When taking nicotinic acid, people with diabetes may have a decrease in blood sugar, attacks of gout, bleeding from the gastrointestinal tract are also possible, and the likelihood of rhabdomyolysis and myopathies .

Reviews

Patients who have been taking statins for a long time as prescribed by doctors or have just started a course of treatment with this group of drugs leave different reviews.

Pavel, 61 years old: I never thought that high cholesterol could be dangerous until I was examined in the hospital. It turned out that my figure was almost twice as high as normal, and atherosclerotic plaques had already begun to accumulate on the walls of my blood vessels. The doctor prescribed me Livazo tablets. They are not cheap, but a month later blood tests showed a clear improvement. I will continue to drink until the doctor stops them or replaces them with others.

Alexey, 47 years old: I had to visit a doctor because recently I began to worry about pain in my legs when walking for a long time. It turned out that cholesterol plaques accumulate in the arteries of the lower extremities and it is necessary to urgently take statins, in addition to the main treatment. They gave me Roxer tablets. There are no side effects, I take 20 mg once a day.

Ekaterina: The doctor prescribed me Atorvastatin 20 mg once a day, because I have high cholesterol in my blood. But after reading articles about the side effects and dangers of this group of drugs, I decided not to take statins for now. I will try to lower my cholesterol through diet and lifestyle changes. I haven’t eaten fatty foods for a week now, I go jogging in the morning, and I quit smoking. A month later I will donate blood again for testing. If cholesterol does not decrease, you will still have to take pills, no matter how much you want.

Statins – past, present, future

Story. Back in the mid-50s. In the 20th century, there was a wide screening of chemical compounds that could affect blood cholesterol levels. At the same time, a substance was found that reduces cholesterol levels by 20–25% and acts at the last stage of cholesterol synthesis. The drug, under the trade name triparanol, moderately reduced cholesterol levels, but led to the accumulation of the precursor in the blood plasma, promoting the further development of atherosclerosis, and it also had serious side effects. Many pharmaceutical companies then completely abandoned the search for cholesterol-lowering drugs. In 1971, Dr. Akira Endo, working in Tokyo (Japan), suggested that the waste products of fungi that grow on a nutrient medium (to obtain better quality penicillin) must also contain natural inhibitors of cholesterol synthesis. After 2 years of work and approximately 6,000 tests, it was discovered that the culture medium of Penicillium citrinium contained a strikingly potent inhibitor of cholesterol synthesis, which was isolated and named ML-236B, later compactin. It was this drug that became the founder of statins. Every more or less significant pharmaceutical company soon began screening microbial cultures not only for antibiotics, but also for cholesterol synthesis inhibitors. Merck began searching for its own statin in 1978, and within 2 weeks. its own inhibitor was isolated - a compound synthesized by fungi (Aspergillus terreus) different from those used by Endo. The substance was named mevinolin (later replaced by lovastatin). The structures of monacolin K, obtained by Endo, and lovastatin, obtained by Alberts, turned out to be completely identical. The same compound, synthesized by two different types of microorganisms, was independently discovered in two different laboratories almost simultaneously! Since that time, with some serious stops, the victorious march of statins began [1]. Previously, no drug has been able to reduce plasma lipid levels so significantly. For example, in the 1984 NIH Coronary Primary Prevention Trial, cholestyramine reduced total cholesterol by only 10% and LDL cholesterol by 20%. Even this was enough to reduce the number of coronary complications by 20%. The result barely reached statistical significance. A recent meta-analysis of 14 statin studies, including a total of 90,056 patients treated with lovastatin, simvastatin, pravastatin, fluvastatin, and atorvastatin, found that the best predictor of a reduction in coronary events was a reduction in LDL-C levels. A decrease in LDL cholesterol by 1 mmol/l reduces the risk of major vascular complications by 20% (Fig. 1). Currently, the mechanism of action of statins is well studied. They inhibit the activity of the enzyme hydroxymethylglutaryl-coenzyme A reductase (HMG-CoA reductase), which converts acetyl coenzyme A into mevalonate, i.e. interrupt the first link in the chain of cholesterol synthesis: acetyl coenzyme A > mevalonate > 5 pyrophosphomevalonate > isopectyl pyrophosphate > 3,3 dimethyl pyrophosphate > geranyl pyrophosphate > farnesyl pyrophosphate > squalene > lanosterol > cholesterol. Evidence-based history. The successful evidence-based history of the use of statins in clinical practice began with confirmation during the 4S (Scandinavian Simvastatin Survival Study) study [8] of the hypothesis that taking a small dose of a statin compared with placebo leads to an improved prognosis of patients with stable coronary heart disease ( IHD) - five-year use of simvastatin in patients with IHD led to a reduction in coronary mortality by 42%, and overall mortality by 30%. There was also a decrease in the incidence of stroke (by 30%), which was previously considered unattainable when using lipid-lowering therapy. Other randomized clinical trials: CARE, LIPID, AF/Tex CAPS, HPS, ASCOT-LLA demonstrated the high effectiveness of not only statins in reducing total cholesterol and LDL cholesterol, but most importantly - reducing the frequency of recurrent complications of coronary artery disease - myocardial infarction (MI), unstable angina, sudden death - by more than 25–40%. Overall mortality also decreased. At the same time, the effect on end points was obtained both in patients with coronary artery disease (4S, CARE, LIPID) and in persons without signs of coronary artery disease (WOSCOPS, AFCAPS/TexCAPS), not only in persons with severe hypercholesterolemia, but also with a relatively low level of cholesterol LDL [2–7]. The seven largest randomized trials can be considered the basic studies on which modern evidence-based practice of using statins is based. In chronological order, they are as follows: • 1994 – 4S (Scandinavian Simvastatin Survival Study) – the first study of this scale, which demonstrated a 42% reduction in coronary mortality in a group of 4444 patients with coronary artery disease (with total plasma cholesterol 5.5–8 .0 mmol/l) against the background of more than 5 years of taking simvastatin at a daily dosage of 20–40 mg [8]. • 1995 – WOSCOPS (West of Scotland Coronary Prevention Study). Against the background of 5 years (4.9 years) of taking pravastatin (40 mg/day) in a group of 6595 men who had not suffered myocardial infarction and suffering from hypercholesterolemia (average total cholesterol level - 7.0 mmol/l), a decrease in the frequency of the development of non-fatal myocardial infarction and death from coronary artery disease by 31% [5]. • 1996 – CARE (Cholesterol and Recurrent Events). A 24% reduction in the incidence of non-fatal myocardial infarction and death from coronary artery disease was demonstrated in a group of 4159 patients with coronary artery disease who suffered a myocardial infarction (total cholesterol level <6.2 mmol/l), against the background of 5 years of taking pravastatin at a daily dosage of 40 mg [ 3]. • 1997 – Post CABG (Post Coronary Artery Bypass Graft). A slowdown in the progression of coronary atherosclerosis (by 31%) was noted in a group of 1351 patients who underwent coronary artery bypass surgery. The effect occurred against the background of 4 years (4.3 years) of taking lovastatin (40 mg/day), which ensured a persistent decrease in the level of low-density lipoprotein cholesterol to 2.5 mmol/l. • 1997 – LCAS (Lipoprotein and Coronary Atherosclerosis Study). In a group of 429 patients with angiographically documented coronary artery disease and moderate hypercholesterolemia, a slowdown in the growth of atherosclerotic plaques in the coronary arteries was noted. The effect was obtained while taking fluvastatin (40 mg/day for 2.5 years). At the same time, the frequency of development of severe clinical manifestations of coronary insufficiency while taking the drug did not change significantly. • 1998 – AFCAPS/TexCAPS (Air Force/Texas Atherosclerosis Prevention Study). In a group of 6805 men and women (average total cholesterol level - 5.71 mmol/l), who received 20-40 mg of lovastatin daily for 5 years, there was a 37% reduction in the risk of developing such manifestations of coronary artery disease as myocardial infarction, unstable angina and sudden coronary death [6]. • 1998 – LIPID (Long-Term Intervention with Pravastatin in Ischemic Disease). In a group of 9014 patients with coronary artery disease who had previously suffered a myocardial infarction or episodes of unstable angina (total cholesterol level - from 4 to 7 mmol/l), a 24% decrease in coronary mortality was noted. The effect was obtained after 6 years (6.1 years) of taking pravastatin (40 mg/day) [2]. Search for the “ideal” statin. Much time has passed since the first statin, lovastatin, appeared on the market in 1987. During this time, target values ​​for total cholesterol and LDL cholesterol levels were constantly reduced based on increasingly new clinical data. At the same time, searches and studies of increasingly effective statins were carried out. After natural lovastatin, semisynthetic pravastatin and simvastatin (the first generation of statins) were obtained. Then came the turn of fully synthetic statins: fluvastatin (second generation), atorvastatin and cerivastatin (third generation). The latest to be clinically studied and actively used was rosuvastatin (fourth generation). Currently, studies are underway on new HMG-CoA reductase inhibitors - glenvastatin, pitavastatin, etc. What place these drugs will take will be shown by studies currently underway. Today, the division of statins by generation does not matter, since no differences in effectiveness have been identified in this parameter. Studies on direct comparison of statins are practically absent or do not meet the requirements of evidence-based medicine (i.e., they take into account surrogate endpoints rather than hard clinical ones), or they compare unequivalent doses of different statins (such as PROVE IT). Therefore, when choosing a statin, one must base it on proven effectiveness compared to placebo. The severity of the lipid-lowering effect of statins increases in the following order: pravastatin < simvastatin < atorvastatin < rosuvastatin. The main characteristics of statins are presented in Table 1. The severity of the lipid-lowering effect of statins was studied by direct comparison in the MERCURY I study (as part of the GALAXY program). The effect of statins on LDL and HDL cholesterol levels was assessed (Fig. 2) [11]. Another study that directly compared the effects of rosuvastatin and atorvastatin was the STELLAR study. A comparative analysis showed that rosuvastatin at a dose of 10–40 mg/day. allowed to achieve target lipid levels in 82–89% of cases, while atorvastatin at a dose of 10–80 mg/day. – in 69–85% of cases [10]. However, the severity of the clinical effects of statins and the quantitative indicators of their influence on the prognosis significantly exceeded the degree of changes in the lipid spectrum of the blood and the degree of influence on angiographic parameters. Analysis of the results of large clinical trials (4S, WOSCOPS, CARE, HPS) revealed significant differences between the actual lipid-lowering component of statin therapy and the degree of its influence on the prognosis. According to the 4S study, it was calculated that the risk of death from coronary heart disease and the number of cases of non-fatal myocardial infarction are reduced by 7% for every 0.6 mmol/l decrease in serum cholesterol during the first two years of statin treatment and by 22% over the next 3-5 years [8]. A decrease in the number of cardiovascular complications was observed earlier than would be expected based on the lipid-lowering effect of a statin alone. In the MARS (lovastatin 40 mg/day) and MAAS (simvastatin 20 mg/day) studies, not only a significant reduction in cholesterol and LDL cholesterol levels was observed, but also a significant effect on the progression of atherosclerosis according to angiography. In addition, statins prevent the development of ischemic strokes, which is not directly related to increased cholesterol levels [12]. Finally, in the HPS study, positive clinical results were achieved in patients at high risk of developing vascular complications of atherosclerosis, regardless of the initial level of cholesterol and LDL cholesterol, i.e. including in individuals with normal lipid profiles [4]. Thus, the categories of patients in whom statins can improve the prognosis include a wide range of nosologies: coronary artery disease (primary and secondary prevention of myocardial infarction), diabetes mellitus, atherosclerosis of peripheral arteries, patients who have suffered a cerebrovascular accident with a high risk of fatal adverse cardiac events. events on the SCORE scale – more than 5%, risk of coronary heart disease on the Framingham scale more than 20%. Theory and practice. According to the EUROASPIRE I and II studies conducted in 1996 and 2001, in just 5 years the average frequency of statin prescriptions in Europe increased 5-fold - from 10.5 to 55.3%, respectively. The frequency of use of this group of drugs in Argentina and Brazil in patients after MI reaches 13%, and in the UK and the USA - 40–60%. However, in Russia this is less than 10% of what should be, and this despite the fact that our country ranks among the first in the world in early mortality from cardiovascular diseases. The main reason seems to be the high cost in the absence of a specific tangible result from taking the drug (adherence to taking acetylsalicylic acid in various forms is much higher, probably due to the lower cost). The risk of side effects and complications of therapy and, finally, the formal attitude towards achieving target lipid levels are also overestimated. Even in prosperous countries of Western Europe, where 70% of patients receive statins to lower cholesterol levels, target values ​​are achieved in only 53% of patients. The most common situation is the classic situation “the cholesterol level has become normal, the course of treatment can be completed” or “temporarily interrupted, let the liver rest.” However, these “normal” numbers are not target values, but rather some “national average” value. Lipid levels soon after stopping the “course of treatment” return to their original values, remaining this way for months and years, while the patient is confident that he has undergone a “highly effective” course of treatment. Another common option is a patient who regularly takes minimal doses of statins with lipid spectrum values ​​that are far from the target, while being confident that he has “atherosclerosis under control.” This situation is partly due to underfunding of health care, but rescuing drowning people remains primarily their business. One of the solutions, in addition to educational work, is to reduce the cost of treatment while achieving maximum lipid-lowering effect while taking a small dose of a statin. The pharmaceutical industry has been working on this for more than 30 years, creating new drugs. Currently, the most effective lipid-lowering agent is rosuvastatin, a fourth-generation drug. The already classic studies STELLAR (2003), SOLAR (2007), COMPELL (2006), MERCURY (2006), ORION (2008), JUPITER (2008), LUNAR (2012) showed that rosuvastatin is significantly superior to other statins in lipid-lowering activity. On average, the reduction in LDL cholesterol during therapy is 52–63% for doses of 10 and 40 mg, respectively. Another real way to reduce the cost of treatment is the use of generic drugs. Currently, one of the popular generics of rosuvastatin is the drug Mertenil in dosages of 5, 10, 20 and 40 mg. Mertenil is in no way inferior to the original drug in terms of pharmacological properties, dosage form, potency, route of administration and quality. The drug is a highly effective and safe drug for primary and secondary prevention of CVD. The evidence base for rosuvastatin is not so extensive due to its “youth”, but the drug has a class effect. Therefore, at present, research is mainly focused on studying the new prospects of powerful statins (rosuvastatin) - the possibility of inhibiting and reversing the development of stenosing atherosclerosis, assessing the effectiveness of treatment in individuals with normal lipid levels, but other “markers” of increased risk. In the JUPITER study (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin), rosuvastatin was administered at 20 mg/day. in 8900 individuals with a low risk of developing atherosclerosis, who had normal cholesterol levels and elevated levels of C-reactive protein, led to a statistically significant reduction in the relative risk of developing severe CVD complications by 44% and overall mortality by 20% [13]. The possibility of regression of atherosclerosis was demonstrated for the first time: in the ASTEROID study, the effect of taking 40 mg of rosuvastatin for 2 years on the course of atherosclerosis of the coronary arteries was studied in 507 patients using intravascular ultrasound. The study achieved a 53% reduction in LDL-C levels, resulting in an average LDL-C level of 1.6 mmol/L. It was shown that the normalized plaque volume in the most affected segment of the coronary artery decreased by 6.8%, and the absolute plaque volume decreased by 9.1% (p<0.001). In 78% of patients, a reverse development of the volume of atherosclerotic plaque was demonstrated [14]. In the ORION study, over two years of treatment with rosuvastatin at doses of 5 and 40 mg/day. a reduction in the number of “dangerous” plaques in the carotid arteries was obtained by more than 40%. For the drug Mertenil (rosuvastatin), in addition to evidence of bioequivalence, a number of studies have also been carried out to study the pleiotropic effects of therapy. In particular, the domestic randomized trial STRELA studied the effect of rosuvastatin on microcirculation parameters and vascular endothelial function in patients with high-risk hypertension and dyslipidemia in comparison with atorvastatin. The study included 82 patients. A significant decrease in the stiffness index, augmentation and reflection indices, and an increase in pulse wave amplitude (as a reflection of endothelial dysfunction) were noted. All these effects were more pronounced in the rosuvastatin group (Mertenil 20 mg/day). In a group led by prof. V.S. Zadionchenko (Moscow) conducted a controlled randomized study of the effectiveness and safety of Mertenil (40 mg/day) in 78 patients with ACS. On the 30th day. from the start of treatment, a 59% decrease in LDL cholesterol levels was achieved compared to baseline values; the treatment was well tolerated. During treatment with Mertenil, a decrease in the frequency of arrhythmic events and the duration of episodes was revealed (according to 24-hour ECG monitoring). It was also noted that Mertenil has a beneficial effect on central hemodynamics and slows down the processes of LV remodeling. A number of patterns have been identified that reflect an improvement in microhemodynamic parameters in patients with ACS during therapy with rosuvastatin [21,22]. The main goal of the 40X40 study was to assess the hypolipidemic efficiency, safety and tolerance of rosuvastatin (Mertenil) at the highest dose of 40 mg/day. Patients of very high cardiovascular risk, who did not reach target levels of LDL cholesterol against the background of current therapy with statins (most patients (18) took atorvastatin, 10 - Simvastatin, 12 - rosuvastatin). When translating patients with current therapy with statins for treatment with murtenil (40 mg/day) without dose titration, an additional decrease in the level of LDL cholesterol was reached by 22.4%, as a result of which the number of patients with the target level of LDL cholesterol has significantly increased. It is often the reason for the cessation of the use or non -validity of statins is the fear of developing side effects. The meta -analysis of the largest studies with statins, which included more than 30 thousand cases of observation with an average duration of more than 4 years, unequivocally showed that the total metabolic effects of statins are about 1-3%, which is comparable to the tolerance of placebo. The development of rabdomiolysis against the background of statins in the entire history of their application throughout the world led to no more than 100 fatal cases, i.e. 0.15 cases per 1 million appointments. For comparison: more than 1000 cases of gastrointestinal bleeding, including fatal acetylsalicylic acid prescriptions around the world. In comparison with the number of prevented fatal cardiovascular events against the background of statins, the conclusion is obvious. However, it is worth remembering drugs that are not recommended to combine with statins because of the risk of the development of myosites and rabdomyolysis: fibrates (risk of rabdomyolysis and hepatotoxicity), nicotic acid and its derivatives (risk of hepatotoxicity), macro -cast antibiotics (erythromycin, clarithromycin), cyclosporine, cyclosporine, cyclosporine, cyclosporine, cyclosporine Azol antifungal agents, verapamil, amiodarone, inhibitors of VIV protease. States that increase the risk of the development of myosites and rabdomyolysis when using statins: combined pathology (diabetes mellitus, chronic renal failure, surgical interventions (cancellation of statins) in elderly patients, insufficient nutrition, liver failure, polyprahmasia, excessive consumption of alcohol, consumption of grapefruit juice [15 ]. In these cases, patients should be under a more thorough supervision of a doctor with the control of enzymes (Alt, AST, GGTP, KFC) at least 2 times a month. At the direction of the American Association for Control over food and drugs (FDA), earlier The section “Precaution measures” was recommended to periodically carry out control of the liver enzymes. The question was raised about canceling the control level of transaminase in general. However, the problem of hepatotoxicity remained: rare, but severe forms of structurally functional disorders of the liver were often diagnosed with non -frequent. Currently, at the direction of FDA, instruction Must be changed and the recommendation must be given blood to analyze the content of liver enzymes before the start of the course of treatment with statins and after its end. Simultaneously with the expansion of the area where statins bring tangible benefits, the boundaries of their effectiveness are also determined. For a long time, the feasibility of prescribing this group of drugs with chronic heart failure is discussed for a long time. The results of previously performed major studies did not allow to answer this question [16,17]. It was noted that the frequency of development of myocardial infarction in such patients is low. In this regard, doubts about the effectiveness of the use of statins in patients with coronary heart disease in the presence of CHF were expressed, since their advantage was mainly manifested in the prevention of myocardial infarction development. At the same time, the results of many informed studies suggested that the use of statins is accompanied by an improvement in the prognosis of patients with heart failure and indicated a positive effect on the LV function and the clinical state of patients with heart failure and non -chechemic nature. The answer to this question was two studies: Corona - an international multicenter prospective randomized doubles of a clan -controlled study of more than 5,000 patients, including Russia, which was planned in order to check the hypothesis that the reception of rosuvastatin at a dose of 10 mg compared with the placebo will lead to a placebo a decrease in the frequency of development of adverse clinical outcomes in patients with clinical manifestations of heart failure of ischemic nature and a reduced systolic function of LV. They included patients aged 60 years and older with CHF corresponding to the II - IV functional class according to the Nyha classification, ischemic etiology and FV LV less than 35–40%. Based on the results of the study, there was no decrease in the combined mortality rate from complications of cardiovascular diseases (SVD) and the frequency of development of non -commercial or stroke [18]. Similar results are demonstrated in the Gissi - HF study, which included patients with heart failure of ischemic and non -hemic etiology. Thus, at present there is no evidence indicating the onset of the onset of statins in patients with pronounced heart failure of ischemic and non -hemic etiology. At the same time, data on the negative impact of statins was also not obtained. Currently, a great perspective has the purpose of drugs, taking into account the genetic characteristics of the patient. Today, up to 13 alleles of the risk of coronary disease are known. The results of several large prospective studies indicate that the polymorphism of the KIF6 gene, which consists in replacing Arginine with a tripophane in position 719, is associated with coronary heart disease. KIF6 encodes kinesins - a class of proteins participating in intracellular transport through the microcanals of organelles of membranes, protein complexes, and MRNA. The carriers of the 719 ARG allele were more at risk of primary and secondary coronary events. This risk allele is very common among the population and increases the risk of myocardial infarction by about 50%. At the same time, statins in this group of patients significantly reduces the risk of coronary events in this category of patients, unlike the “non -vomiting”. The number of patients who need to be treated to prevent one coronary event among carriers of the 719 ARG alleles varied from 10 to 20 people, compared with more than 80 patients for “non -lines” (according to Care, Woscops, Prove IT -Timi 22 Study) [19]. Assessment of the carriage of this genetic polymorphism opens up a broad perspective to improve the risk of coronary events and optimize therapy. Thus, atherosclerosis is considered an irreversible and integral satellite of aging. The appearance of statins allowed partly to take control of this process and reduce mortality. During the opening of the first inhibitor of the GMGOA -reductase by the Japanese scientist ENDO, statins (Mertenil) became a rotary point in the prevention of cardiovascular diseases due to atherosclerosis. Numerous studies have demonstrated that statins can extend not just a person’s life, but his active, full -fledged life. Literature 1. Daniel Steinberg // J. Lipid. Research. 2004. Vol. 47. P. 1339–1351. 2. Lipid Study Group. Titles (A) Design Features and Baseline Characteristics of the Lipid (Long - Term International with Pravastatin in ISCHEMIC Disease) Study: A RANDOMIDE TRIAL IN Ute Myocardial Infarction and/Or Unstable Angina Pectoris (B) Prevention of Cardiovascular Events and Death With Pravastatin in Pathents with Coronary Heart Disease and Broad Range of Initial Cholesterol Levels. References (a) // am. J. Cardiol. 1995. Vol. 76. P. 474–479 (b); N.Engl. J. Med. 1998. Vol. 339. P. 1349–1357. 3. Sacks FM, Pfeffer Ma, Moye La et al. The Effect of Pravastatin On Coronary Events After Myocardial Infarction in Patients with Average Cholesterol Levels. Cholesterol and Recurrent Events Trial Investigators // N. English. J. Med. 1996. Vol. 335. P. 1001–1009. 4. Heart Protection Study Collaborative Group. MRC/BHF Heart Protiation Study of Cholesterol Lowering with Simvastatin in 20.536 High - Risk Individuals: A RANDOMISED PLACEBO - CONTROLLLED TRIAL // LANCET. 2002. Vol. 360. P. 7–22. 5. Shepherd J., Cobbe SM, Ford I. et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group // N. English. J. Med. 1995. Vol. 333. P. 1301–1307. 6. Gotto am et al. Relation Between Baseline and On - Treatment Lipid Parameters and First Acute Major Coronary Events in the Air Force Coronary Atherosclerosis Prevention Study (Afcaps/Texcaps) // Circulation. 2000. Vol. 101. P. 477. 7. Sever PS, Dahlof B., Poulter Nr et al. Prevention of Coronary and Stroke Events with Atorvastatin in Hypertensive Patients Who Have Average - Thanaage Cholesterol Concentrations, In the Anglo - Scandinavian Cardi AC Outcomes Trial - Lipid Lowering ARM (Ascot - Lla): A Multicentre Randomated Controlled Trita // Drugs. 2004. Vol. 64 (SUPPL. 2). P. 43–60. 8. RANDOMISED TRIAL of Cholesterol Lowering in 4444 PATIENTS WITH CORONARY HEART Disease: The Scandinavian Simvastatin Survival Study (4s) // Lancet. 1994. Vol. 344. P. 1383–1389. 9. Martin Mj et al. // Lancet. 1986 II. P. 933–936. 10. Jones PH, Davidson MH, Stein Ea et al. For the Stellar Study Group. Comparison of the Efficacy and Safety of Rosuvastatin Versus Atorvastatin, Simvastatin, and Pravastatin Across Doses (Stellar Tial) // AM. J. Cardiol. 2003. Vol. 92. P. 152–160. 11. Schuster H. et al. Effects of Switching Statins on Achievument of Lipid Goals: Measurning Effective Reductions in Cholesterol USING ROSUVASTATIN THEERYAPY (MERCURY I) StUDY // AM. Heart J. 2004. Vol. 147. P. 705–712. 12. Bellosta S., Ferri N., Paoletti R., Corsini A. Non - Lipid --related Effects of Statins // Ann. Med. 2000. Vol. 32. P. 164–176. 13. Ridker PM, Danielson E., Fonseca Fah et al. Rosuvastatin to Prevent Vascular Events in Men and Win with Elevated C - Reactive Protein // N. English. J. Med. 2008. Vol. 359. P. 2195–207. 14. Nissen S. et al. Effect of Very High --intensity Statin Therapy on Regression of Coronary Atherosclerosis. The Asteroid // Jama. 2006. Vol. 295 (13). P. 1556–1565. 15. Pharmacotherapy of chronic cardiovascular diseases. Guide for doctors / Ed. L.I. Olbinskaya. - M.: Medicine, 2006. 16. Collins R., Armitage J., Parish S. et al. Effects of Cholesterol - Lowering with Simvastatin On Stroke and Other Major Vascular Events in 20536 PEOPLE CEREBROVASCULAR DISEASE OrbH - RISK CONDIONS // LANCET. 2004. Vol. 363. P. 757–767. 17. Shepherd J., Blauw GJ, Murphy Mb et al. Pravastatin in Elderly Individuals at Risk of Vascular Disease (Prosper): A RANDOMIZED CONTROLLLED TRIAL // LANCET. 2002. Vol. 360. P. 1623–1630. 18. Kjekshus J., Dunselman P., Blideskog M. et al. A statin in the Treatment of Heart Failure? Controlled Rosuvastatin Multinational Study in Heart Failure (Corona): Study Design and Baseline Characteristics // EUR. J. Heart Fail. 2005. Vol. 7. P. 1059–1069. 19. American Journal of Cardiology. 2010. Vol. 106, Issue 7. P. 994–998. 20. IAKOBOVA OA et al.// jacc. 2008. Vol. 51. P. 449. 21. Zadionchenko V.S., Shakhrai NB, Shekhyan G.G. et al. Features of the pharmaceutical and clinical properties of rosuvastatin // breast cancer. - 2011. - No. 12. - S. 772–778. 22. Zadionchenko V.S., Shekhyan G.G., Shakhrai N.B. et al. The effect of rosuvastatin on lipid metabolism, microcirculation and central hemodynamics in patients with acute coronary syndrome // Consilium Medicum. - 2011. - No. 5. - S. 85–89. 23. Gilyarevsky S.R., Orlov V.A., Kuzmina I.M. et al. Hypolypidemic effects of intensive modes of the use of statins in the treatment of patients with acute coronary syndrome: approaches to choosing the drug and its dose // Cardiol. and cardiovascular. hir. - 2012. - No. 5 (4). - S. 36–41.

Drawing conclusions

Statins are a group of drugs created to reduce the concentration of cholesterol in the blood, prevent the serious consequences of heart and vascular diseases, surgical operations and diabetes.

Despite a lot of rumors about these drugs, if the attending physician considers it appropriate to prescribe statins, this recommendation should not be neglected. You can supplement therapy at home by eating healthy foods, but it is unreasonable to perceive this as the only correct method of treatment.

Reception features

Despite the unpleasant effects of treatment, statins are quite capable of extending a patient’s life by ten years. For each patient, the dosage is selected individually: it is important to find the line between benefits and side effects. When trying to understand how to take statins correctly, at what time and under what conditions, patients can follow certain tips.

For better absorption, tablets should be taken once a day, a couple of hours before bedtime.

Statins are swallowed with water or any juice other than fresh grapefruit: this can cause serious complications.

Another important recommendation is to avoid alcohol. Sometimes, to reduce the chances of a side effect, the doctor may recommend a course of treatment with short breaks.