Analysis of the organization of provision of hypoglycemic drugs to patients with type 2 diabetes mellitus in the constituent entities of the Russian Federation

“High cholesterol” does not hurt, but it can lead to the development of atherosclerosis. Atherosclerosis affects the cardiovascular system, leading to the formation of atherosclerotic plaques and blood supply disorders. This often ends in heart attacks and strokes.

Today there are many drugs from the statin group. They have been shown to be effective in reducing mortality from cardiovascular disease, but debate continues about their safety. To achieve and maintain the desired levels of lipid metabolism, long-term use of drugs is required, but many patients do not follow the recommendations, causing the effectiveness of treatment to sharply decrease. What to say about patients when doctors have different opinions on this matter.

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.

Reviews

Evgeniy, 55 years old, Rostov: About 6 months ago I had a myocardial infarction. After rehabilitation at the sanatorium, I took a cholesterol test and found it was elevated. The attending physician prescribed Crestor in the minimum therapeutic dosage. I took it for a month and my cholesterol dropped to normal. The drug is effective, but the downside is a side effect in the form of diarrhea. I dealt with it with the help of bifidobacteria.

Irina, 39 years old, Moscow: I took Torvacard for almost a year. Prescribed for high cholesterol and increased risk of heart ischemia. While taking it, constant headaches appeared. The doctor prescribed the latest generation drug - Rosuvastatin, and Torvacard was noted. I have not seen any side effects from the new medicine yet. Judging by the blood test, cholesterol decreased by 30%. I will continue to take it.

Mikhail, 45 years old, Stavropol: I weigh almost 100 kg, a blood sugar test showed prediabetes. In addition, cholesterol levels are elevated. The attending physician recommended following a diet without fatty and fried foods and prescribed statins. We chose Rosucard and decided on the dosage. I’ve been taking it for almost 2 months, and my cholesterol levels have dropped by a third. The body accepted the medicine without any problems.

Statins to lower cholesterol

Before taking such drugs, you need to know what statins are - what they are, the benefits and harms of such drugs, etc. Statins are chemicals that in the body reduce the production of enzymes necessary for the process of cholesterol synthesis.

In the instructions for such drugs you can read the following:

• They reduce the concentration of cholesterol in plasma due to inhibition of HMG-CoA reductase , as well as a decrease in cholesterol synthesis in the liver.
• Reduce cholesterol concentrations in people suffering from homozygous familial hypercholesterolemia , which is not amenable to treatment with lipid-lowering drugs.
• Their mechanism of action makes it possible to reduce total cholesterol levels by 30-45%, and “harmful” cholesterol levels by 40-60%.
• When taking statins, HDL cholesterol and apolipoprotein A increase.
• The drugs reduce the likelihood of ischemic complications by 15%, in particular, according to cardiologists, the risk of angina pectoris and myocardial infarction is reduced by 25%.
• No mutagenic or carcinogenic effects are observed.

Use in children and pregnancy

Children should not be given statins: their effect on a growing body has not been studied enough, and the benefits may be offset by complications. Such tablets are prohibited for use before the age of 18 and can only be prescribed in cases of familial hypercholesterolemia. Even in such cases, not all drugs are indicated for prescription.

Separately, it is worth noting the impossibility of treating pregnant women with statins; Even the safest medications are not prescribed in the absence of adequate contraception. This is due to the fact that changes in cholesterol synthesis can deprive the child of substances necessary for development. When planning a pregnancy, you need to stop taking statins a month before pregnancy, and you cannot feed your baby breast milk while the mother is taking statins.

Side effects

Numerous negative effects may occur after administration:

• Frequent side effects: asthenia , insomnia , headache , constipation , nausea , abdominal pain, diarrhea , myalgia , flatulence .
• Digestive system: diarrhea, vomiting, hepatitis, pancreatitis , cholestatic jaundice, anorexia .
• Nervous system: dizziness , amnesia, hypoesthesia, malaise, paresthesia, peripheral neuropathy.
• Allergic manifestations: rash and itching of the skin , urticaria , anaphylaxis , exudative erythema, Lyell's syndrome.
• Musculoskeletal system: back pain, myositis , cramps , arthritis , myopathy .
• Hematopoiesis: thrombocytopenia .
• Metabolic processes: hypoglycemia , diabetes mellitus , weight gain, obesity , impotence , peripheral edema.
• The most severe complication of statin treatment is rhabdomyolysis , but this occurs in rare cases.

National Society for the Study of Atherosclerosis

The mechanism of action of statins is well studied. Statins inhibit the activity of the enzyme hydroxymethylglutaryl-coenzyme A reductase (HMG-CoA reductase), which converts acetyl coenzyme A into mevalonate, that is, they 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

There is no generally accepted classification of statins; usually statins are listed in chronological order, according to their appearance. Statins can be classified according to their hydrophilicity, their metabolism by the cytochrome P450 system, and the strength of their lipid-lowering effect. Tables 1 and 2 show the main characteristics of statins [1,2].

Table 1.

Table 2.

Classification according to the strength of influence on the lipid spectrum of the blood

According to the severity of the lipid-lowering effect, statins can be arranged in order of weakening effect (Fig. 4).

Figure 4. Severity of the lipid-lowering effect of statins

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 [3]. Another study that directly compared the effects of rosuvastatin and atorvastatin was the STELLAR study. It demonstrated that a 10 mg dose of rosuvastatin was 3-4% more effective in lowering LDL cholesterol than a 20 mg dose of atorvastatin. Therapy with rosuvastatin at a dose of 10-40 mg led to a decrease in LDL cholesterol by 46-55%, therapy with atorvastatin at a dose of 10-80 mg led to a decrease in LDL cholesterol by 37-51% [4].

A comparative analysis showed that rosuvastatin at a dose of 10-40 mg/day. allowed to achieve the target lipid level in 82-89% of cases, while atorvastatin at a dose of 10-80 mg/day - in 69-85% of cases (Fig. 5) [4].

Figure 5. Effect of statin therapy on LDL and HDL cholesterol levels (STELLAR study results) [4]

In addition to the lipid-lowering effect, statins have an effect on atherosclerotic plaque, inflammatory factors and endothelial function (pleiotropic effects).

Effect of statin therapy on atherosclerotic plaque size

The correlation of LDL cholesterol levels with angiographic findings has been shown in several studies (Fig. 6) [5-10].

Figure 6. Correlation of LDL cholesterol levels with atherosclerotic arterial disease

The effect of intensive rosuvastatin therapy on the size of atherosclerotic plaque was convincingly demonstrated in the recently completed ASTEROID study [11]. This study examined the effect of rosuvastatin on the course of coronary atherosclerosis using intravascular ultrasound. The study included 507 patients with atherosclerosis of the coronary arteries (reduction of the lumen by no more than half the diameter for at least 40 mm). Treatment with rosuvastatin at a dose of 40 mg lasted 2 years.

Endpoints were changes in relative, absolute, and normalized plaque volume (RPV, AVP, and NPV). As a result, a decrease in AOB in the most affected segment of the coronary artery was shown by 6.8%, a decrease in AOB in the assessed segment of the coronary artery by 0.79%, a decrease in AOB in the most affected segment of the coronary artery by 9.1% (p

Figure 7. Reduction of atherosclerotic plaque during therapy with rosuvastatin 40 mg/day. for 2 years (ASTEROID study). Sonograms provided by Cleveland Clinic Core Laboratory (EEM - outer elastic membrane)

Effect of statins on inflammatory factors

In patients with atherosclerosis, certain cellular and humoral changes occur. The activity of cytokines, acute phase proteins, growth factors, and adhesion molecules increases. It has been established that the main factor initiating the synthesis of C-reactive protein (CRP) by hepatocytes is cytokines, primarily interleukin-6 (IL-6) [12]. Since CRP, interleukins and adhesion molecules are markers of inflammation, a decrease in their levels can be regarded as a positive effect. The mechanism of CRP reduction under the influence of statins is currently being actively studied [13]. Statins help weaken the expression of the IL-1 family of interleukins (IL-1?, IL-1?), which have a pro-inflammatory effect [14], and reduce the level of soluble protein (sCD40L) associated with the tumor necrosis factor TNF-?. High levels of sCD40L are associated with an increased incidence of recurrent cardiovascular events [15,16]. The anti-inflammatory effects of statins are also known, for example, their effect on the activation of leukocytes and the reduction of CRP levels [17,18]. It has been shown that the proinflammatory cytokine tumor necrosis factor, which impairs endothelial function, can be inhibited in macrophages by statin therapy [19].

The fact that statin therapy leads to a decrease in CRP levels has been established based on the results of large-scale studies. The analysis included studies with all statin drugs, including rosuvastatin. The anti-inflammatory effect of statins was discovered after studying their lipid-lowering effect. The ANDROMEDA study compared the effect of rosuvastatin and atorvastatin in reducing LDL cholesterol and CRP concentrations in patients with diabetes mellitus. Although the decrease in CRP concentration when taking rosuvastatin at doses of 10 and 20 mg exceeded the effect of atorvastatin at the same doses by 6-13%, these differences were not significant [20]. However, it can be said that rosuvastatin therapy has a pronounced effect on the level of CRP and other indicators of inflammation [18].

The results of the PROVE-IT TIMI 22 study [21] show that, given the same lipid levels during statin therapy, patients with low CRP values ​​had better outcomes after myocardial infarction or less progression of atherosclerosis according to intravascular ultrasound.

The target level for CRP reduction in the REVERSAL study [22] was 2.0 mg/l; this level of CRP is approaching the population level. Pravastatin (40 mg/day) and atorvastatin (80 mg/day) were compared. During pravastatin therapy, the absolute volume of atheroma increased by 2.7%; during atorvastatin therapy, cessation of atheroma growth was achieved (-0.4%, p = 0.98). Patients who simultaneously decreased plasma concentrations of both CRP and LDL-C had slower progression of coronary atherosclerosis as measured by intravascular ultrasound, as shown in this study [22].

The effect of statins on inflammatory factors continues to be studied in the ongoing JUPITER trial. JUPITER is a large, prospective, placebo-controlled study of rosuvastatin in patients without apparent hyperlipidemia (LDL-C 2.0 mg/L) [23].

Effect of statins on endothelial function

Dysfunction of the endothelium also plays an important role in the pathogenesis of IHD [24,25]. Endothelial dysfunction may serve as a marker for the early stages of cardiovascular disease [26]. Stimulation of nitric oxide synthesis or reduction of peroxide levels restores endothelial function. Drugs with similar properties include statins and angiotensin-converting enzyme (ACE) inhibitors [27].

Although the main effect of statins is a positive effect on the lipid spectrum, it is reliably known that reducing LDL cholesterol levels improves endothelial function [28,29]. Restoration of endothelial function [30,31] during treatment with statins leads to a reduction in cardiovascular risk [32,33]. Clinical studies confirm that a similar effect appears after 16 weeks of treatment [34], and it is not associated only with a decrease in LDL cholesterol levels [35]. This so-called pleiotropic effect of statins is explained by the fact that statins inhibit the synthesis of geranylgeranyl pyrophosphate, which activates the Rho protein (effector proteins, which are kinases that control cellular functions) [36]. This protein, based on guanosine triphosphate, regulates a large number of specific cellular reactions [37], changing the permeability of the vessel wall [38], causing adhesion and migration of monocytes through the endothelium [39]. Other mechanisms of action of statins are less clear; It is believed that statins may improve endothelial function directly and indirectly. For example, lovastatin and simvastatin have been shown to induce transcription of eNOS (endothelial nitric oxide synthase) genes in endothelial cells [40]. Thus, the pleiotropic effects of statins are no less important than the lipid-lowering ones.

Other possible effects of statins

In addition to those mentioned above, other effects of statins are discussed [41], but it should be noted that these effects have not been proven in large studies, so we recommend treating them with some skepticism.

1. Dilation of the coronary arteries.
2. Preventing spasm of the coronary arteries.
3. Stimulation of coronary angiogenesis.
4. Inhibition of vascular smooth muscle cell proliferation.
5. Inhibition of platelet aggregation, reduction in the number of platelets and red blood cells, due to which blood viscosity decreases.
6. Reducing thrombin levels and stimulating fibrinolysis, reducing the level of plasminogen activator inhibitor.
7. Increased NO synthesis by endothelium.
8. Inhibition of macrophage migration into the vascular wall.
9. Antioxidant action.
10. Immunosuppressive effect.
11. Reducing albuminuria in diabetes mellitus.
12. Reduction of left ventricular hypertrophy.
13. Antiarrhythmic effect.
14. Slows the progression of Alzheimer's disease and dementia.

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Who needs to take statins?

Informing what statins are, advertising stories and instructions for the drugs indicate that statins are effective drugs for lowering cholesterol, which significantly improve the overall quality of life, and also reduce the likelihood of developing strokes and myocardial infarction . Accordingly, taking these pills every day is a safe method to lower your cholesterol levels.

But in fact, until today there is no accurate information about whether treating patients with such medications is really so safe and effective. After all, some researchers claim that the potential harm and side effects outweigh the benefits of statins as a prophylactic drug used to prevent cardiovascular diseases. Experts are still arguing whether it is worth taking statins, weighing the pros and cons. Doctors' forums almost always contain debates on the topic “Statins - pros and cons.”

But, nevertheless, there are certain groups of patients for whom statins are required.

The latest generation statins must be used:

• for the purpose of secondary prevention after a stroke or heart attack ;
• for reconstructive surgical interventions on large vessels and the heart;
• in case of myocardial infarction or acute coronary syndrome ;
• with ischemic disease with an increased likelihood of stroke or heart attack.

That is, anticholesterol drugs are indicated for coronary patients in order to increase their life expectancy. In this case, to reduce side effects, the doctor must select the appropriate medicine and monitor biochemical parameters. If there is a 3-fold increase in transaminases, statins are discontinued.

The advisability of prescribing medications from this group for such patients is questionable:

• at low risks;
• for diabetes mellitus ;
• in women before menopause.

If statins are prescribed to people with diabetes, they may need additional tablets to lower their blood , since statins raise their blood sugar in such patients. Medicines to lower blood sugar should only be prescribed and their dosage adjusted by a doctor.

Currently in Russia, the treatment standards for most cardiac pathologies include the use of statins. But although medical prescription reduces mortality, this is not a prerequisite for prescribing drugs to all people with coronary artery disease or hypertension. They should not be used by anyone over 45 years of age or by anyone with high cholesterol levels.

It is important to consider the compatibility of these drugs with other drugs.

If necessary, together with anticholesterol drugs, the doctor prescribes other drugs for the treatment of cardiovascular diseases: Diroton , Concor , Propanorm , etc.

Diroton (active ingredient - lisinopril ) is used to treat arterial hypertension.

Concor (active component - bisoprolol hemifumarate ) is used for the treatment of arterial hypertension , heart failure, angina pectoris .

Representatives of the latest generation statins

The latest generation of statins can effectively normalize blood lipid levels while taking medications in a minimal dose. Their undeniable advantage is the minimum of side effects. This fact allows them to be prescribed for the treatment of elderly patients.

New generation statins are significantly superior to other generations of medications in terms of effectiveness and safety. When taking them, the level of low-density lipoproteins decreases, along with a simultaneous increase in the content of good cholesterol.

List of drugs related to new generation statins:

• Rosuvastatin,
• Tevastor,
• Rozulip,
• Mertenil,
• Akorta,
• Rosecard,
• Crestor.

They are presented in tablet form and have different dosages. Some of them, for example, Akorta and Rosuvastatin, are produced by Russian manufacturers. The names of the drugs are different, but the active ingredient in them is the same - rosuvastatin. This is a selective inhibitor of coareductase, which is the “ancestor” of cholesterol itself.

Tablets based on it help increase low-density lipoprotein receptors in hepatocytes. This allows you to enhance the capture and stimulate the breakdown of low-density cholesterol. As a result of the action of these drugs, there is a simultaneous decrease in the level of bad cholesterol and triglycerides.

The therapeutic effect of modern statins appears gradually. In the first 7 days from the start of treatment, it is practically unnoticeable. But already from the 2nd week their effectiveness reaches 90%. Their maximum effect appears in the 4th week of continuous use and remains stable thereafter.

New generation cholesterol-lowering drugs have the least side effects. At the same time, they cannot be completely excluded. Basically, a negative reaction affects the functioning of the liver and kidneys. Therefore, in severe pathologies of these organs, careful prescription of statins is required, taking into account their benefits and possible risks.

Latest generation statins effectively reduce bad cholesterol levels

Statin drugs, which belong to the latest generation of drugs, have good reviews from those who took them to lower cholesterol levels. The greatest pronounced effect from taking new generation statins can be achieved when treatment is combined with an anti-cholesterol diet.

List of statin drugs

Which drugs are statins, and what their cholesterol-lowering activity is, can be found in the table below.

Classification of statins

In medicine, certain parameters are taken into account for classification.

Origin:

• Synthetic: Cerivastatin , pitavastatin , Rosuvastatin , Fluvastatin , Atorvastatin ).
• Semi-synthetic: Simvastatin , Pravastatin .
• Natural: Lovastatin .

By generation:

• First generation: lovastatin ( Choletar , Cardiostatin );
• Second generation: simvastatin ( Vasilip , Simvacard , Simvastatin , Simvor , Simvastol , Simgal , Zocor , Owencor , Sincard , etc.), pravastatin ;
• Third generation: atorvastatin ( Atomax , Tulip , Liprimar , Atoris , Torvacard , Liptonorm , Lipitor ), cerivastatin , fluvastatin .
• Fourth generation: pitavastatin , rosuvastatin ( Crestor , Akorta , Mertenil , Roxera , Rosuvastatin , Rozulip , Rosucard , Rozart , Tevastor ).

Cholesterol Pills Review

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 .

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.

Research on the effects of statins on the body

Previously, cardiologists prescribed statins to people suffering from coronary artery disease , arterial hypertension , and those with low risks of cardiovascular pathologies.

Currently, the attitude towards this type of drugs among some specialists has changed. Although in Russia there have not yet been full-fledged independent studies of the effects of statins on the body.

Meanwhile, Canadian scientists claim that after using statins, the risk of cataracts in patients increased by 57%, and if the person had diabetes , by 82%. Such alarming data were confirmed by statistical analysis.

Experts analyzed the results of fourteen clinical studies that were conducted to study the effect of statins on the body. Their conclusion was that this type of medication reduces the likelihood of strokes and heart attacks, but given the serious side effects, they are not prescribed to people who have not previously suffered strokes or heart disease. According to researchers, people who regularly take such medications develop the following side effects:

• renal failure;
• cataract;
• liver dysfunction;
• depression , mood swings;
• myopathy;
• memory losses.

But in general, there are different points of view on whether these drugs are harmful or relatively safe.

• Scientists from Germany have proven that with low cholesterol levels, the likelihood of developing cancer , liver disease and a number of other serious ailments, as well as early mortality and suicide, increases, thereby confirming that low cholesterol levels are more dangerous than high ones.
• Researchers from the USA claim that heart attacks and strokes do not develop due to high cholesterol, but due to low levels of magnesium in the body.
• Statins can inhibit the important function of cholesterol in repairing disorders in body tissues. In order for the body to grow muscle mass, and for its normal functioning in general, low-density fat cells, that is, “bad” cholesterol, are needed. If its deficiency is noted, myalgia and muscular dystrophy .
• When taking such drugs, cholesterol production is suppressed, and accordingly, the production of mevalonate , which is not only a source of cholesterol, but also a number of other substances. They perform important functions in the body, so their deficiency can provoke the development of diseases.
• This group of medications increases the likelihood of developing diabetes mellitus , and this disease leads to increased cholesterol levels. Various sources claim that if you take statins for a long time, the risk of diabetes ranges from 10 to 70%. Under the influence of these drugs, the concentration of the GLUT4 protein in the cell, which is responsible for blood glucose levels, decreases. British researchers have proven that taking such medications increases the risk of diabetes in women by 70% after a menstrual break.
• Negative side effects develop slowly; accordingly, the patient may not immediately notice this, which is dangerous with prolonged use.
• When using statins, there is an effect on the liver. Those who are obese or lead a sedentary lifestyle note an improvement in their vascular condition for a period of time. But over time, complex processes in the body are disrupted, which can lead to a deterioration in mental processes, especially in older people.

When a person under 50 years of age has elevated cholesterol levels, this indicates that serious disorders are developing in the body that need to be treated. In some countries, programs are being implemented at the national level to promote lowering cholesterol levels by promoting an active lifestyle, changing dietary principles, quitting nicotine addiction, and using statins.

As a result, this method “worked” in many countries: mortality from cardiovascular diseases decreased significantly. However, there is an opinion that quitting smoking, physical activity and changing the menu are a better way to prolong life than using medications that have contraindications and side effects.

Statins for older patients

Among the arguments in favor of the fact that older people should take statins only after carefully weighing the harm and benefits, we can recall a study that involved more than 3 thousand people aged 60 years and older who took statin medications. Approximately 30% noted muscle pain, as well as decreased energy, high fatigue, and weakness.

Muscle pain is most severe in those who have just started taking such medications. As a result, this condition reduces the intensity of physical activity - it is difficult for people to exercise and walk, which ultimately leads to an increased risk of strokes and heart attacks. In addition, a person who moves little begins to gradually increase body weight, which is also a risk of cardiovascular disease.

Choosing the best product

The effectiveness of drugs of different generations differs significantly: this becomes especially noticeable if a comparison is made immediately between the first and fourth. The quality of Crestor's work is 4 times higher than the capabilities of the best of the first drugs - Simvastatin. The higher the generation, the lower the likelihood that the treatment will cause harm, and the better the tolerability. Therefore, the search for the best medicine should be carried out between the leaders of the last two groups.

Liprimar wins on price: treatment is relatively inexpensive. In general, atorvastatin has been used more widely and has a greater track record of predictable results. Since the patient must take statins daily for many months, the choice of Liprimar helps to reconcile the effectiveness of treatment, safety and budget. Nevertheless, the drug takes a long time to start working: the rate of development of the initial effect is almost 2 times behind that of rosuvastatin.

Crestor, on the other hand, is more effective and can help in difficult cases. Most often, rosuvastatin is better tolerated, and the high rate of influence on cholesterol synthesis allows it to win the competition for the quality of the result and the reduction of consequences. The only question remains is the price.

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.

Contraindications for statin treatment

• Kidney and liver problems;
• The period of bearing a child and breastfeeding;
• Susceptibility to the components of the drug;

An important role in the practice of using statins is played by the fact that in Russia a very small percentage of patients take medications after their prescription. If in America 95% of patients take medications, in Europe this figure reaches 55%, but in our country it is a modest 12%. There are many reasons: fear and distrust of medicine and the habit of most Russians to let everything take its course.

All other medications

Your doctor may recommend taking dietary supplements (dietary supplements).

However, natural remedies such as Omega 3 , Tykveol , flaxseed oil , and lipoic acid lower cholesterol levels slightly.

It should be borne in mind that dietary supplements are not drugs, therefore such drugs are inferior to statin drugs in terms of preventing cardiovascular diseases.

List of dietary supplements that are used for this purpose and contain natural components:

• Omega Forte;
• Doppelhertz Omega;
• Tykveol;
• Lipoic acid;
• SitoPren.

Omega 3

Tablets containing fish oil ( Omega 3 , Oceanol , Omacor ) are recommended for people who want to lower cholesterol. Fish oil protects the body from the development of vascular and heart diseases, as well as from depression and arthritis. But you need to drink fish oil very carefully, since taking it increases the risk of chronic pancreatitis .

Tykveol

Pumpkin seed oil is indicated for use by those who suffer from cholecystitis , cerebral atherosclerosis hepatitis . The product provides choleretic, anti-inflammatory, antioxidant, hepatoprotective effects.

Lipoic acid

This remedy is an endogenous antioxidant , it is used for the prevention and treatment of coronary atherosclerosis. There is a positive effect of the drug on carbohydrate metabolism. When taken, the trophism of neurons improves, and glycogen levels in the liver increase.

Vitamins

Vitamins help normalize cholesterol levels, increase hemoglobin , etc. The body needs vitamin B12 and folic acid , nicotinic acid . At the same time, it is very important that these are natural vitamins, that is, it is important to eat those foods that contain these vitamins.

SitoPren

Dietary supplement – ​​fir foot extract, it contains beta-sitosterol, polyprenols. Should be taken for hypertension , atherosclerosis , high levels of triglycerides and cholesterol.

Policosanol

Dietary supplement – ​​plant wax extract. Helps reduce low-density cholesterol levels and helps prevent atherosclerosis.

Other means

Bile acid sequestrants ( Kolesevelam , etc.) are medications that are used in complex treatment as an auxiliary component for lowering cholesterol. They suppress its synthesis in plasma.

Ciprofibrate Lipanor - suppresses cholesterol synthesis in the liver, lowers its level in the blood, reducing the level of atherogenic lipoproteins.

Review of drugs from other groups to reduce cholesterol

Statins were isolated and reviewed separately because they are the most commonly prescribed drugs. But besides statins, there are other groups of drugs that reduce the amount of unwanted cholesterol in the blood plasma. These are nicotinic acid, ion exchange resins such as cholestyramine, fibric acid derivatives, which include Clofibrate. Let's consider some drugs that are often prescribed by doctors in the complex treatment of hypercholesterolemia in patients with high cardiac risk.

Ezetrol (ezetemibe)

Popularity rating*: 4.9

Ezetrol is a drug that reduces “bad” cholesterol in the blood plasma through a different mechanism. It does not affect liver enzymes, but prevents the absorption of cholesterol from food in the intestines. Thus, cholesterol reserves in the liver are gradually depleted after the administration of Ezetrol, and then its concentration drops in the blood. This drug is indicated for the treatment of atherosclerosis, hypercholesterolemia, and can be used either independently or in conjunction with statins under medical supervision. But the main indication is severe hypercholesterolemia, which is inherited genetically and manifests itself in various family cases.

Ezetrol is prescribed at any time of the day, regardless of food intake. The starting dosage of Ezetrol is 10 mg once daily. The cost of one package of 28 tablets, designed for a monthly course, averages 2000 rubles, and Ezetrol is produced by the well-known pharmaceutical company Schering-Plough. Numerous generic versions of this drug have not yet been identified.

Advantages and disadvantages

The advantage of Ezetrol is its unique mechanism of action and good tolerability. Adverse effects were mild and often resolved without dosage adjustment or discontinuation of treatment. The most common side effects were headache and abdominal discomfort. Ezetrol may be contraindicated in severe liver failure, with hypersensitivity to the components, and this drug should not be used simultaneously with a drug from the fibrate group.

Ezetrol is not recommended for use by pregnant and lactating women, but only for the reason that no studies have been conducted, but this is a very sufficient argument for discontinuing the drug if pregnancy occurs. But Ezetrol can be used in conjunction with statins, and then the speed of achieving target cholesterol levels is significantly higher than when prescribing separate treatment. However, even if Ezetrol is prescribed, the patient must follow a diet aimed at reducing the amount of dietary cholesterol.

Omacor

Popularity rating*: 4.8

Omacor reduces bad cholesterol in the blood plasma in a completely different way. These are no longer tablets, but soft gelatin capsules, which are transparent and contain a light yellow fatty liquid. The active ingredient of Omacor is Omega-3 unsaturated acids, namely a mixture of ethyl esters of two representatives of these acids.

Additionally, the capsules contain vitamin E, or alpha-tocopherol, which is fat-soluble. Omacor affects the concentration of very low density lipoproteins (VLDL) and reduces their number. It reduces the concentration of free fatty acids, and numerous research results have shown that those patients who regularly took one capsule of Omacor daily for 3.5 years showed a decrease in overall mortality, and also had fewer myocardial infarctions and strokes.

Omacor is used as a means to prevent heart attack, with elevated cholesterol levels as an addition to drug therapy. Omacor can be used independently, without prescribing drugs from the group of statins. But at the same time, the patient must first begin to follow a cholesterol-lowering diet. Omacor is produced by the pharmaceutical company Banner Pharma, located in Germany and the Netherlands, and one package of 28 capsules, designed for monthly use, will cost 1,657 rubles at the pharmacy.

Advantages and disadvantages

A big advantage of Omacor is the flexibility of prescription: in patients with low cholesterol levels it can be prescribed alone, and in cases of severe hypercholesterolemia it is used in conjunction with statins. Omacor has proven effectiveness and is well tolerated. It will be contraindicated only during pregnancy, lactation and sensitivity to the components of the drug. Omacor is contraindicated if there is a significant intake of triglycerides with food.

However, it should be used with caution in persons under 18 years of age, in the elderly, and in patients with severe liver and kidney impairment. Special medical supervision is also required when used simultaneously with fibrates. The most common side effects were various dyspeptic symptoms, such as abdominal discomfort and bloating. Omacor is a good, reliable, auxiliary drug for the treatment of any stages of hypercholesterolemia: from the severe familial form as part of complex therapy, to the mild one.

Lipantil (fenofibrate)

Popularity rating*: 4.7

Fenofibrate belongs to fibric acid derivatives, and reduces the concentration of triglycerides and very low density lipoproteins in the blood, which are ultimately transformed into “bad” cholesterol. This drug is available in capsules, each capsule contains 200 mg of fenofibrate. This is a means of influencing triglyceride metabolism. As a result of its use, the synthesis of fatty acids is disrupted and the concentration of cholesterol decreases. Lipantil also improves blood flow and slightly reduces the concentration of sugar in plasma, so it can be prescribed to patients with diabetes.

Studies show that Lipantil lowers total cholesterol by 25%, and it is indicated in the complex therapy of hypercholesterolemia, which cannot be corrected by diet. Lipantil is prescribed with food, one capsule per day. The duration of the course is determined by the doctor. Lipantil is produced by the French company Ripharm, and a package of 30 capsules, designed for a monthly course, costs, on average, 1000 rubles.

Advantages and disadvantages

Lipantil is contraindicated in cases of muscle tissue pathology, including hereditary ones, in case of severe damage to the liver and kidneys, as well as in case of intolerance to fibrates. It is not used in children under 18 years of age, in pregnant and nursing mothers, or in patients with lactase deficiency. The drug is well tolerated, but it must be prescribed by a doctor, since if it is combined with statins as self-medication, there may be complications on muscle tissue. If a patient uses Warfarin after a heart attack or stroke, or other anticoagulants, there may be a risk of bleeding. Lipantil should not be prescribed with monoamine oxidase inhibitors (MAOIs). All these precautions, if applied in a timely manner, including monitoring the level of liver enzymes in the blood serum during treatment, can achieve a significant reduction in cholesterol.

Good and bad cholesterol, what's the difference?

Cholesterol is a substance vital for the normal functioning of the body. It is a building material for cells, is responsible for the elasticity of cell membranes, and is necessary for the synthesis of vitamin D and hormones. Produced in the liver, the deficiency is replenished with food (yolks, fatty meats, smoked meats). For a healthy person, the maximum (safe) amount of cholesterol obtained from food should not exceed 0.3 g. This amount is contained in a serving (200 g) of fried pork or 150 g of smoked sausage.

Cholesterol is usually divided into “bad” and “good”. The fact is that cholesterol itself is a fatty, insoluble (in the blood) substance. It moves through the bloodstream by joining proteins or transport fats - these compounds are called lipoproteins. Lipoproteins are the same in shape, but differ in density and size.

“Good” are lipoproteins of small size with high density, “bad” are low density and, accordingly, large in size. It is the latter that settle on the walls of blood vessels, interfere with normal blood flow and, as a result, contribute to the development of strokes and heart attacks.

Nutrition and cholesterol

The level of cholesterol in the blood largely depends on a person’s diet, namely the quality of fats contained in food. For example, monounsaturated fats are beneficial because they reduce the amount of “bad” lipoproteins. The main source of such fats is almonds, pistachios, natural vegetable oils (olive, sesame).

But the human body cannot synthesize Omega 3 polyunsaturated fatty acids on its own, and a deficiency leads to the formation of atherosclerotic plaques. You can, of course, buy amino acid complexes, but it is better to include fatty fish, seafood or walnuts in your diet.

Sources of “bad” cholesterol are saturated and trans fats. The former are found in ice cream, cream, sausages and fatty meats. The second is found in almost all confectionery products (sweets, cakes) containing palm oil. The danger of trans fats is that in addition to increasing the level of “bad” cholesterol in the blood, they help reduce good cholesterol.

Is it true that age affects cholesterol levels?

Yes its true. For comparison, in a newborn child the level of cholesterol in the blood is 1.3-2.6 mmol/l, in adults these figures are 2-3 times higher. You should go to the hospital if a blood test shows a cholesterol level of 7.8 mmol/l (normal value 6.2) - this is hypercholesterolemia that requires urgent treatment. Doctors recommend annual examinations starting at age 25. It is possible earlier if one of the family members suffers from excess cholesterol.

Myth 4. Taking statins in large doses leads to the resorption of plaques and cleaning of blood vessels

In fact . Alas. This is wrong. Despite taking statins, plaques, which are quite complex formations inside the vascular wall, usually remain the same size. The advantage of taking drugs from this group is different: under the influence of statins, an existing atherosclerotic plaque is stabilized and becomes less dangerous due to the fact that the likelihood of violating its integrity and embolism (blockage) with fragments of smaller arteries, as well as thrombosis, is reduced.

How to lower cholesterol levels

The easiest way is to reconsider your lifestyle. The recommendations are standard – moderate physical activity and a balanced diet. Here are some effective ways:

1. Jogging is the easiest way to “shake yourself up.” No costs for special equipment and obvious benefits for the body.
2. Include fish dishes in your diet. To preserve maximum beneficial Omega-3 acids, steam, boil or bake fish.
3. Add finely chopped garlic to salads (if there are no problems with the gastrointestinal tract) - 2-3 cloves a day is enough.

Important: these methods are only suitable in cases where the cholesterol level is not much higher than the normal value. In the rest, you need to contact a specialist who will prescribe medication.

Comparison of ease of use of Roxera and Atorvastatin

This includes dose selection taking into account various conditions and frequency of doses. At the same time, it is important not to forget about the release form of the drug; it is also important to take it into account when making an assessment.

The ease of use of Roxera is approximately the same as Atorvastatin. However, they are not convenient enough to use.

The drug ratings were compiled by experienced pharmacists who studied international research. The report is generated automatically.

Last update date: 2021-01-10 10:02:28

Comparison of the safety of Roxera and Atorvastatin

The safety of a drug includes many factors.

At the same time, in Roxera it is quite similar to Atorvastatin. It is important where the drug is metabolized: drugs are excreted from the body either unchanged or in the form of products of their biochemical transformations. Metabolism occurs spontaneously, but most often involves major organs such as the liver, kidneys, lungs, skin, brain and others. When assessing the metabolism of Roxera, as well as Atorvastatin, we look at which organ is the metabolizing organ and how critical the effect on it is.

The risk-benefit ratio is when the prescription of a drug is undesirable, but justified under certain conditions and circumstances, with the obligatory observance of caution in use. At the same time, Roxera does not have any risks when used, just like Atorvastatin.

Also, when calculating safety, it is taken into account whether only allergic reactions occur or possible dysfunction of the main organs. In other matters, as well as the reversibility of the consequences of using Roxera and Atorvastatin.