Statins in Primary and Secondary Prevention of Coronary Heart Disease

Iako je općeprihvaćena opravdanost davanja inhibitora HMG-CoA reduktaze (statina) radi smanjenja ukupnog i LDL-kolesterola u serumu bolesnika s koronarnom bolešću srca (KBS) i onih koji zbog hiperlipidemije imaju povećani rizik, donedavno nije bilo tako jasno treba li statine davati i osobama s manje izraženim rizikom. Rezultati novijih velikih kliničkih ispitivanja i gotovo dva desetljeća kliničkih iskustava sa statinima pokazuju da su oni vrlo djelotvorni u smanjenju rizika za KBS i u primarnoj i u sekundarnoj prevenciji, i to bez češćih i značajnijih neželjenih nuspojava. Korisni učinci statina nadmašuju one postignute u ranijim ispitivanjima s drugim antilipemicima i pojavljuju se prerano da bi se mogli pripisati samo snižavanju koncentracije lipida u serumu. Stoga se smatra da do toga ne dolazi samo zbog jačeg smanjenja lipida u serumu, već zbog tzv. pleiotropnih protuaterosklerotskih učinaka statina. Novija klinička ispitivanja jasno su pokazala da se davanjem statina ne postiže samo liječenje hiperlipidemije, već uistinu smanjenje pobola i pomora od KBS-a u osoba s povećanim rizikom. Međutim, u nekoliko je ispitivanja uočeno da mnogi bolesnici s KBS-om (a još više onih koji samo imaju velik rizik) ili uopće ne dobivaju statin, ili se u njih zbog preniske doze statina ne postižu ciljne, odnosno preporučene vrijednosti lipida. Budući da je hipodoziranje statina važan problem, osobito u nas, tomu valja posvetiti posebnu pozornost.Although treatment with HMG-CoA reductase inhibitors (statins) to reduce total and LDL-cholesterol is clearly indicated in patients with coronary heart disease (CHD) and those with increased risk due to hyperlipidemia, the requirements of patients with lower risk were until recently less straightforward. The results of recent large clinical trials with statins and almost two decades of clinical experience have shown that statins are effective and well tolerated in reducing CHD risk for both primary and secondary prevention. The beneficial effects of statins outweigh those seen in earlier trials with other hypolipemic drugs and occur too early in treatment to be due to lipid lowering mechanism alone. Therefore this happens presumably not only because of the greater reduction in lipids but because of their so-called “pleiotropic” antiatherogenic effects. Recent clinical trials have proved that lipid lowering therapy with statins is no longer just a matter of hyperlipidemia treatment but rather a way of lowering risk of CHD morbidity and mortality in a large number of individuals at high risk. However, the data from several studies have shown that many CHD patients (and even more individuals at high risk) either receive no treatment at all, or are not treated to recommended lipid goals. Since undertreatment is a big problem, particularly in Croatia, this issue should be strongly addressed