Home » High cholesterol: yes to the summer diet, but do not send therapies on vacation

High cholesterol: yes to the summer diet, but do not send therapies on vacation

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High cholesterol: yes to the summer diet, but do not send therapies on vacation

Hot. The heat that becomes unbearable. And the pressure drops. Furthermore, if we are on vacation, we feel less stress. This certainly helps the heart and arteries in those who are hypertensive and for this reason it may be meaningful to talk to the doctor if it is necessary to reduce the therapy, without self-prescribing decreases in dosages that can be dangerous. But for cholesterol, if you follow a cure, it is better not to touch anything. Even if we eat healthier, favoring fruit and vegetables, and maybe on vacation we move more: nutrition alone, together with physical activity, can reduce LDL cholesterol values ​​(the bad one), to a maximum of 10-15 per hundred. And often it is not enough. Following the Mediterranean diet, drinking a lot and exercising helps. But don’t forget the treatments indicated by the doctor. Failure to adhere to medical prescriptions is a very widespread phenomenon and above all of great impact in the treatment of chronic diseases. “In Italy in 2020 an overall cost related to cardiovascular diseases is estimated to be 23 billion euros, an increase compared to the 18 billion estimated in 2014 ha recently reported Giorgio Colombo, Scientific Director Cefat – Center for Pharmaceutical Economics and Health Technologies, Department of Pharmaceutical Sciences of the University of Pavia. The treatment of dyslipidemias with lipid-lowering drugs, an important risk factor for cardiovascular disease, is characterized by a low rate of adherence by patients, which generates therapeutic failures, extensions or changes in reimbursed therapies and an increased risk of hospitalization “.

How important are good habits

Regular movement and Mediterranean nutrition are the basis for controlling cardiovascular risk and obviously also for dyslipidemia. “Regular physical activity, even of low or medium intensity, is essential: it is important that this is at least 30 but better 50 minutes every day and you can choose any aerobic activity that gives you well-being – he explains Carlo Tumscitz, of the Cardiological Center of the University of Ferrara. With such hot days, however, you must be careful to choose the times: the early morning or late evening are preferable because otherwise it is possible to run into the risks of heatstroke. The risk is greatest when you carry out intense activity in the presence of high temperatures and even worse if in the presence of high humidity, which reduces the protective mechanism of sweating. “This is precisely the situation in our cities in summer. It would therefore be better to favor swimming , when possible, since it is free from these risks. “For the rest, summer days lead to consuming small and light meals rich in vegetables and this instead is very good for those with high LDL cholesterol: it should also greatly reduce the alcohol consumption. The heat is therefore not the enemy of the fight against dyslipidemia but it is necessary to choose well the physical activity and the times to practice it. Or, whenever possible, prefer our mid-mountain resorts, where temperatures are higher. All this, obviously continuing with the prescribed therapies “.

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The more cholesterol goes down, the better

There is no “too low” level of LDL cholesterol: whoever is lucky enough to have very low values ​​for a positive genetic mutation (unfortunately not too frequent) has a very low cardiovascular risk. For others and in particular in those who have already had an event, the drastic reduction of values ​​becomes the fundamental pillar of medium and long-term therapy. “Some drugs are well known (statins) but in recent years we have learned to use them in combination with other drugs (ezetimibe) to enhance their effect by reducing side effects – continues the expert. the spread of the new PCSK-9 inhibitor drugs represented an incredible step forward in reducing therapeutic failures. These drugs have been able to drastically reduce LDL values ​​in patients resistant or intolerant to statins and to ezetimibe. ” In short: even in summer it is necessary to lower “bad” cholesterol as much as possible to protect patients at high cardiovascular risk. And it is necessary to continue with the prescribed treatments, without sending them on vacation. Especially if you are at high risk. In this sense, the Italian Medicines Agency recently chose to lower the threshold levels of LDL cholesterol from 100 to 70 milligrams per deciliter (mg / dL) for the use of PCSK9 inhibitors in secondary prevention. “This decision marks an important turning point by allowing early intervention in patients at high cardiovascular risk – he comments Ciro Indolfi, president of the Italian Society of Cardiology. Today it has been shown that LDL cholesterol is the cause of atherosclerosis and therefore its reduction represents one of the main objectives for limiting cardiovascular events such as myocardial infarction and mortality. This is why the guidelines of the European Society of Cardiology recommend in high-risk patients a decrease in LDL cholesterol below 55 mg / dL and even, in some categories, below 40 mg / dL. These ambitious goals can now also be achieved thanks to PCSK9 inhibitors that have demonstrated a clear clinical benefit in high-risk patients “.

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Medicines, strategies for the future

While awaiting the next availability of bempedoic acid, other ways to act on cholesterol that are too high are being studied, obviously with different objectives from person to person based on the risk profile. The focus is on inclisiran (a stable RNA that interferes with the synthesis of PCSK9) which after a starting cycle can only be administered twice a year, just like a vaccination that requires its booster, in cases where the subjects need drastic drops in LDL cholesterol values ​​because they are at very high risk. The medicine acts on PCSK9, a protein present in the body, and uses RNA-interference technology. Thanks to this original mechanism of action, it prevents the synthesis of the PCSK9 protein by inhibiting the use of PCSK9 RNA to form the PCSK9 protein that encodes it. In this sense it works in a different way than the two monoclonal antibodies already available for medical prescription, which instead block the already expressed PCSK9 protein, not working on its synthesis. Finally, to act directly on the plaques already present inside the arteries, we work to evaluate the effects of the apolipoprotein apoA-I, a kind of “sponge” capable of absorbing the lipids with which it comes into contact to the point of detaching them from the lesion classic of atherosclerosis inside the vessels. The clinical study “Aegis-II“is sponsored by Harvard University and aims to recruit about 20,000 subjects through 1,035 centers around the world, including the Irccs MultiMedica of Sesto San Giovanni which has already enrolled its first patient.

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