Elsevier

Medicina Clínica

Volume 150, Issue 10, 23 May 2018, Pages 398-402
Medicina Clínica

Review
Statins: pros and consPros y contras de las estatinas

https://doi.org/10.1016/j.medcli.2017.11.030Get rights and content

Abstract

Statins inhibit the critical step of cholesterol synthesis in which 3-hydroxy-3-methylglutaryl coenzyme A (HMGC) is transformed to mevalonate by the enzyme HMGC reductase. By doing so, they have a potent lipid-lowering effect that reduces cardiovascular risk and decreases mortality. Since the mevalonate pathway also influences endothelial function, the inflammatory response, and coagulation, the effects of statins reach well beyond their cholesterol lowering properties. As with all drugs, statins may have adverse effects; these include musculoskeletal symptoms, increased risk of diabetes, and higher rates of hemorrhagic stroke. However, the frequency of adverse effects is extremely low and, in selected patient populations, the benefits of statins considerably outweigh the potential risks.

Resumen

Las estatinas inhiben el paso crítico de la síntesis del colesterol, donde la enzima 3-hidroxi-3-metilglutaril A (HMGC) se transforma en mevalonato por medio de la enzima HMGC reductasa. Al hacerlo, tiene un potente efecto reductor de lípidos que reduce el riesgo cardiovascular y disminuye la mortalidad. Como la vía del mevalonato influye también en la función endotelial, la respuesta inflamatoria, y la coagulación, los efectos de las estatinas van más allá de sus propiedades reductoras del colesterol. Como todos los fármacos, las estatinas pueden tener efectos adversos que incluyen síntomas musculoesqueléticos, incremento del riesgo de diabetes y tasas superiores de accidentes hemorrágicos. Sin embargo, la frecuencia de estos efectos adversos es extremadamente baja y, en poblaciones seleccionadas de pacientes, los beneficios de las estatinas superan con creces los riesgos potenciales.

Section snippets

Lipid lowering effect

Cardiovascular disease (CVD) is currently one of the most important health problems in the world, causing one-third of all global deaths (17.3 million deaths per year).6

In the early 20th century, cholesterol plaques were found within the coronary arteries of patients who had died after suffering from angina pectoris.7 Coincidentally, in the period from 1900 to 1960, the percentage of deaths due to coronary heart disease (CHD) increased from 10% to 40%. However, little was known at that time

Cons of statins

Notwithstanding the unquestionable benefits of statins in patients at risk for cardiovascular events, they also have the potential to cause side effects. The two best documented side effects in observational studies and clinical trials are an increased risk of myopathy and an increased incidence of diabetes. There is also some reliable evidence that statins increase the risk of hemorrhagic stroke. Other side effects, such as the potential to impair memory and cognition, promote cataract

Conclusion

In conclusion, statins are highly effective drugs that have the ability to reduce the risk of major cardiovascular events up to 10% in primary prevention and 5% in secondary prevention over 5 years. However, about 0.5–1% patients over this same period of time may develop side effects, most of them mild. Nevertheless, given the great number of patients under statin treatment, these adverse effects will be common in clinical practice and thus, must be well-known by the medical community in order

Conflict of interests

The authors declare no conflict of interests.

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