The importance of intensive lowering of LDL cholesterol – the role of "potent" statins

Povećani LDL kolesterol glavni je čimbenik rizika za kardiovaskularne bolesti (KVB), poglavito koronarnu bolest srca i infarkt miokarda. Lijekovi izbora za smanjenje LDL kolesterola su statini. Velika su istraživanja pokazala da je za prevenciju KVB važno postići što je moguće nižu koncentraciju LDL kolesterola u krvi. To je posebno važno u sekundarnoj prevenciji, dakle u bolesnika s dokazanom koronarnom bolešću, preživjelim infarktom miokarda, tranzitornom ishemijskom atakom ili moždanim udarom, onih s dokazanim ateroskleroznim suženjem karotidnih ili perifernih arterija te dijabetičara. Međutim, oko 50% bolesnika s dokazanom KVB, unatoč liječenja statinima, ne postižu ciljne vrijednosti lipida koje bi sukladno smjernicama trebali imati. Možda bi rješenje tog problema mogla biti šira uporaba „jačih” statina koji snažnije smanjuju LDL kolesterol. Rosuvastatin, koji je „najjači” statin na hrvatskom tržištu, osim najsnažnijeg smanjivanja LDL kolesterola ima i neka druga dodatna korisna svojstva kao što su povećanje zaštitnog HDL kolesterola i smanjenje triglicerida, smanjenje hsCRP te smanjenje rizika venskih tromboembolija i renoprotektivne učinke. Intenzivno liječenje „jačim” statinima značajno smanjuje lipidni sadržaj ateroskleroznih nakupina što upućuje da bi oni mogli imati i učinke u smislu stabiliziranja tih nakupina. To bi moglo dodatno objasniti njihovu veliku djelotvornost u smanjenju smrtonosnih i nesmrtonosnih kardiovaskularnih događaja.Increased LDL cholesterol is the main risk factor for cardiovascular (CVD) diseases, particularly coronary heart disease (CHD) and myocardial infarction (MI). The treatment of choice for elevated LDL cholesterol are statins. Large clinical trials have shown that lowering of LDL cholesterol is crucial for prevention of CVD and that there is no lower threshold for benefits of such lowering. This is particularly important in secondary prevention, i.e. in patients with CHD, MI, transitory ischaemic attacks (TIA), stroke, in those with atherosclerotic changes of carotic or periphery ateries and in diabetic patients. However, approximately 50% of patients with CVD still do not attain LDL cholesterol goals according to the guidelines despite the use of statin therapy. Therefore, the use of more potent statins which produce greater reductions of LDL cholesterol when compared with other agents in this class might be a solution. Rosuvastatin, being the most potent statin on Croatian market, provides additional benefits in the lipid profile apart from strongest LDL cholesterol lowering such as increasing HDL cholesterol and decreasing triglycerides, decreasing hsCRP, as well as reducing the risk of venous thromboembolism and preserving renal function. Aggressive lipid-lowering therapy with more potent statins can significantly reduce the lipid content of the atherosclerotic plaques which implies that they may be able to stabilize plaques. This can additionally explain their efficacy in reducing fatal and nonfatal cardiovascular events