Sometimes it starts late. In other cases, you forget to take the daily tablet. But it also happens that, over the years, someone may find it less useful to continue statin therapies to lower bad or LDL cholesterol. And that’s a big mistake, as stopping treatment with these drugs early could significantly reduce long-term protection against cardiovascular disease, as many of the cholesterol-lowering benefits – we never forget that the less the better – they are observed later in life. To underline the importance of not abandoning treatments is a “mathematical” research presented at the congress of the European Society of Cardiology (ESC) underway in Barcelona by a team coordinated by Runguo Wu of Queen Mary University of London.
Heart door
High cholesterol: yes to the summer diet, but do not send therapies on vacation
by Federico Mereta
Important to start early
The study clearly indicates that those over-40s who are at high risk, with a high probability of having cardiovascular disease, or in any case all those who already have heart disease should speak with their caregiver to evaluate whether to start treatment. But above all it points to another aspect: “Stopping treatment, unless advised by a doctor, does not seem to be a wise choice”, Wu points out.
The research estimated the accumulation of benefits with statins based on the age of initiation of therapy using a simulation based on data from nearly 120,000 subjects participating in statin studies from Cholesterol Treatment Trialists and half a million people from the UK database. Biobank. Treatment with a standard dose of statin was used to estimate the effect of therapy versus no therapy in these scenarios: lifetime therapy (used until death or up to 110 years of age, whichever is earlier), discontinuation of therapy at 80 years of age and delayed initiation of therapy by five years in participants under the age of 45.
How much is earned for men and women
By measuring a parameter called QALY (each QALY equals one year of life in perfect health) and considering all the other factors, it was found that most of the QALYs gained from statin therapy accrued later in life. The higher the 10-year cardiovascular risk of the participants, the greater and earlier was the benefit of statins. Compared to lifelong statins, discontinuing therapy at age 80 canceled much of the potential benefit, especially for people with relatively low cardiovascular risk.
In particular, people who start taking statins at age 50 but quit at age 80 instead of continuing for life will lose 73% of QALY benefit if they have a relatively low cardiovascular risk and 36% if they have an elevated cardiovascular risk. Particular attention should be paid to women who have a generally lower cardiovascular risk than males. “This means that for women most of the statin benefits over the course of life occur later and premature discontinuation of therapy is likely more harmful than for men,” says the expert.
The “fatty” liver puts (also) the heart at risk
by Federico Mereta
Targeted care for each person
What is certain is that high cholesterol is difficult to successfully counter. According to the data of the Santorini study on over 9000 people with specific problems, there is a substantial underestimation of the dangers. “Today we clearly know that” lower is better “, that is, the more we lower our cholesterol the better – he recalls Alberico CatapanoProfessor of Pharmacology at the University of Milan and Irccs Multimedica – but the treatments must be carefully studied based on the reduction you want to obtain “. of Ldl in people at very high risk (such as those who have had a heart attack or stroke) or at least halve the values and 70 for those at high risk “.
Heart disease, we learn to recognize risk factors
How drugs help us
“Compared to some time ago, today we have different drugs available based on therapeutic objectives – resumes Catapano. In the coming months, bempedoic acid should also be available in Italy, which inhibits the synthesis of cholesterol in the liver and does not show any action. on the muscles of statins, as well as being associated with ezetimibe and the same statins in those who need them “. The important thing is to think based on the results you want. In subjects at very high risk, monoclonal antibodies can be used which act as “scavengers”, counteracting the activity of a particular protein, called PCSK9, which in the body degrades the receptors for LDL found on the surface of the liver cells. Finally inclisiran is expected: after a starting cycle, this drug (a stable RNA that interferes with the synthesis of PCSK9) can only be administered twice a year and help people to drastically reduce Ldl values. Obviously the important thing is to always persevere in the challenge to LDL cholesterol. Only by following the treatments prescribed over time can this causal factor (such as diabetes and hypertension) of ischemic cardiovascular diseases be countered.