The group of diseases of the circulatory system (the ischemic heart, such as heart attacks or angina, and cerebrovascular) remains the leading cause of death in Spain, and is on the rise. In 2017, deaths due to this reason increased by 2.2% with respect to the previous year, according to the latest data published by the INE.
An illness that is associated with hypercholesterolemia (high amount of good and bad fat in blood, greater than 250 mg / dl), especially in cases of ischemic heart disease, whose prevalence is 41% in Spaniards aged 35 to 74 years, says Dr. Jordi Vilaseca Canals, specialist in family and community medicine at l'Hospitalet de Llobregat, in an article published in the journal AMF of the Spanish Society of Family and Community Medicine (Semfyc).
Diet and exercise is the most effective medical prescription even with medication
As a rule, changes in food habit (Mediterranean diet), the incorporation of physical exercise and smoking cessation (if this is the case) is the medical recommendation that prevails over the use of drugs, especially in patients with low probabilities and without previous medical history. An effort of six months – the term granted by the doctor – which, in many cases, is not met.
When is the taking of a medication then justified? "It depends on the characteristics of each individual. It is indicated if you have suffered a heart attack, regardless of how your cholesterol is. If you have diabetes and the bad [LDL] is above 100. While in patients with low risk, who have no disease of any kind, the indication is justified if it is greater than 100 ", explains Dr. Antonio Pérez, coordinator of the lipid and cardiovascular risk working group of the Spanish Society of Endocrinology and Nutrition (SENN).
The most popular
Statins are the most prescribed family of medicines in the world, the first choice in diagnoses of hypercholesterolemia, including Spain, where they also resort to simvastatin or atorvastatin. However, in general, several studies warn of its side effects, specifically when the treatment includes high doses.
"Minor" and "less frequent" muscle pain, liver toxicity, flushing, diarrhea or gallstones are some of the known adverse effects. Added to this is the recent possibility of suffering diabetes type 2, the most common (90% of patients suffer from it, older in general, according to Pérez), after the Jupiter study of 2010 that proved the efficacy of the powerful rovastatin.
The risk-benefit of statins is under discussion, since it is associated with the onset of diabetes in patients taking high doses
"Many factors intervene. The mechanism is not well known. Some studies suggest that it increases the body's resistance to insulin, that is, it requires more of this hormone to obtain the same effects, or that it decreases its production. What is clear is that this occurs in people already at risk of developing diabetes: obese, with prediabetes or older, "he clarifies.
Currently, there is a debate about its risk-benefit due to its widespread use in the population. "They are drugs that have been shown in multiple studies to decrease the likelihood of heart attacks and other vascular diseases, especially in patients with previous cardiovascular disease or diabetics with high predisposition," argues Vicente Arrarte, president of the vascular risk and cardiac rehabilitation section of the Spanish Society of Cardiology (SEC).
But admit that relationship. "It is true that, in some cases, a slight predisposition to diabetic debut has been described in most statins, but well used and prescribed, the risks are clearly lower than the advantages," he says. Dr. Perez, of the SEEN, also defends them. "It remains a very safe and effective drug, its benefits far outweigh the risks," he says.
The doctors point out that this "bad publicity" has also caused a nocebo effect: that the patients attribute adverse symptoms to the medication due to the negative expectations they already have and abandon the therapy due to this unjustified fear.
Administration. As with aspirin or omeprazole, the use of statins should not be universalized without indication, suggests Vicente Arrarte, president of the vascular risk and cardiac rehabilitation section of the Spanish Society of Cardiology (SEC). "Bad employee, can give more problems than benefits. It is a drug, not a food option, "he says.
Awareness Health education is key. The patient has to be aware because, in fact, the medication does not work on its own. "When it comes to a patient with these characteristics, it is essential to diet and exercise whether or not to take drugs. Especially if we already know that they may have a higher chance of suffering from diabetes. It is the most effective measure of prevention ", says Antonio Pérez, coordinator of the working group of lipids and cardiovascular risk of the Spanish Society of Endocrinology and Nutrition (SENN).
New molecules Pérez mentions pitavastatin, the last incorporated, which "seems to have a somewhat more neutral effect" with respect to the secondary reactions cited. But, he says, information is lacking and confirmation of this approach is expected. The so-called monoclonal antibodies, such as alirocumab or evolucumab, are other innovators already available that are used alone or in combination with statins.