Medicus, Vol. 11 No. 1_Farmakologija, 2002.
Review article
The Role of Hypolipemic Drugs Today
Željko Reiner
Abstract
A significant number of well designed, large
clinical trials published during the last 8 years have demonstrated
the benefits of cholesterol reduction using HMG-CoA
reductase inhibitors (statins) in patients with coronary heart
disease (CHD) with elevated but also with average levels of
total and LDL cholesterol. A reduction in ischaemic events
has also been seen within the first year after initiation of
statin treatment of acute coronary syndromes in several trials.
The cardiovascular benefits of statins exceeded those
seen in earlier trials with other hypolipemic drugs presumably
not only because of the greater reduction in LDL-cholesterol
but their mechanisms of action beyond lipid lowering. These
non-lipid-related effects of statins are discussed in this review
as well. Statins are also capable of reducing ischemic stroke
risk by approximately one-third in patients with evidence of
vascular disease. The efficacy of statins has been extended
also to the primary prevention of CHD in subjects with hypercholesterolemia
but also in those with average cholesterol
levels and high risk for CHD. This is particularly true for diabetic
patients because among them statin therapy is likely to
be as effective and cost-effective as treating nondiabetic individuals
with CHD. Fibrates lower plasma triglycerides and
raise HDL cholesterol. However, the trials with fibrates indicated
no benefits in terms of reduction in risk of coronary
deaths. Hope remains, however, that some new data will
result from ongoing trials with fibrates.
Keywords
statins; fibrates; coronary heart disease; diabetes; acute coronary syndromes
Hrčak ID:
19947
URI
Publication date:
13.2.2002.
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