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Seven things that people with HIV need to know about statins, LDL and heart health

Blood cells and heartMost people have a blood test called "panel" lipid done when they passed in consultation with your doctor. Have you ever wondered why your doing these tests and what they seek? And if you are already taking a drug like Lipitor, did you know that in addition to lowering your cholesterol, you may also prevent cancer? Vivek Jain, MD, but, assistant professor of medicine in the HIV division / AIDS at the General Hospital of San Francisco, shared his experience on LDL cholesterol, statins, and the latest research on heart health for people living with HIV in a recent rounds of presentation at the Grand General Hospital of San Francisco HIV / AIDS. Here's what we learned.  

What is cholesterol is and why it is very bad

Cholesterol is a substance produced by the cells of our body that help us do things like digest food and produce hormones and vitamin D. Also eat cholesterol in certain foods we eat. Generally, we need cholesterol, but consume it in too have high levels of it in the blood can be harmful because it can cause plaque buildup in your arteries (one called atherosclerosis condition), which can lead to heart attacks or strokes.

On statin drugs and who should take

People get prescriptions for statin drugs to lower blood cholesterol levels. (A healthier diet and exercise may lower cholesterol levels.) The most commonly prescribed statins are Lipitor (atorvastatin), Pravachol (pravastatin and rosuvastatin Crestor ().) Service providers have been used to decide whether or not they want to a person should take statins based on their low-density lipoprotein (LDL) cholesterol - particles that carry the fat molecules to the cells and lead to the building of cholesterol in the arteries.The latest guidelines say that statins are recommended based on whether a person is at a predictable risk of cardiovascular events (such as heart attack or stroke). avc-removal-plate-300x240
"At the end of 2013, the new American Heart Association and the American College of Cardiology's new guidelines came out. You get a risk prediction score "global", which gives you a ten-year risk of a cardiovascular event. Statins are recommended when the risk ten years is over 7,5%, which is considerable when the risk is between 5% and 7,5%, "said Jain. "[Doctors] still need clinical analysis [to decide whether or not a person should take a statin], but we are trying to get away from LDL goals and move toward risk objectives."

The difference in how well statins work for people with HIV

"Studies show that statins work very well and they are very potent HIV-negative [people]. They actually reduce LDL levels in plasma reliably in most patients, "said Jain. But they work well for people living with HIV? A study on pesoas taking statinsIncluding 616 people living with HIV and 5.451 people who were HIV negative, they found a significant difference in the percentage of reduction of LDL among HIV-positive people (25,6%) and HIV negative people (28,3%). Statins were more effective in people who were HIV negative and the difference in this study among HIV-negative patients and HIV positive was statistically significant, said Jain.
This gap closed, however, for people with HIV in use of atorvastatin - statins more frequently and more powerful, prescribed that suffered a drop in LDL levels that were not significantly different from the decline observed by HIV negative people. "The overall message is that our patients get a similar drop in LDL compared to HIV-negative patients, so there is not an issue to worry about," said Jain.

Statins reduce the likelihood of death

Few studies have examined the question of whether statins are not able to prevent cardiac mortality and morbidity. "This is the whole reason we have to start with the prescription of statins," said Jain.A worry, he said, it is that the increased inflammation caused by HIV-even with successful antiretroviral therapy increases the risk of heart disease and death. But even that statins reduce lipids, researchers wonder if excessive inflammation prevents statins effectively reduce mortality.
I usually say, "lifelong, I died a thousand deaths." And in fact, I believe that I have already exceeded this figure and can not disentangle in predictions, how many deaths I live (...) until chegeu for mercy addition, the death of the car. The fact is that every time you receive a text that refers to the damage that HIV causes to the brain and neural network, I argue in his own cause, since, from the beginning, when mminha primary HIV infection was configured in a meningitis, he, the virus has acted slowly and silently in my cérbro (I see my sanity is slipping away, little by little) and in my neural network (...) and God knows the level of concentration that is necessary so I do not make typos, so I do not lose the thread in my reasoning and how much I suffer with s pain, physical and moral, of Neuroparia Peripheral who corrodes me the nervous system. However, in spite of everything, and he died so often, I like to think that the death of the car come as esa of illustration and will make Herculean efforts to reach me, crawling like a snail, snail travesty ....

I usually say, "throughout life, I died a thousand deaths." And in fact, I believe that I have already exceeded this figure and can not disentangle in omens, how many deaths I live (...) until it reaches for mercy addition, the death of the car. The fact is that every time you post a text that refers to the damage that HIV causes to the brain and neural network, I argue in his own cause, since, from the beginning, when mminha primary HIV infection was configured in meningitis, he, the virus has acted slowly and silently in my cérbro (I see my lucidity little to-fading and little) and in my neural network (...) and God knows the level of concentration that is required for I do not make typos, so I do not lose the thread in my reasonings and how much I suffer with s pain, physical and moral, of the Peripheral Neuroparia who corrodes me the nervous system. However, in spite of everything, and he died so often, I like to think that the death of the car comes as esa of illustration and will make Herculean efforts to reach me, creeping like a snail, snail ... travesty.

He pointed to a study byMoore and colleagueswhich included 1.538 people with HIV who had suppressed viral loads at the undetectable level, and followed them between 1998 and 2009. During that time, there were 85 deaths from 7 people who were taking a statin and 78 people who were not having a statin. The researchers estimated that statin reduced the chance of death by 67%. Ina larger study, by Drechsler and colleagues, with 25.000 veterans found a small reduction in the risk of death with the use of statins around 5% to 10%. A third study by Overton and colleagues with more than 3.500 patients found a reduced risk of death, although the impact of statins on mortality was not statistically significant in their analysis. "Overall, I would like to say that the evidence that statins reduce mortality has not been as clear for people living with HIV as it has been for HIV-negative people. But there does appear to be a trend showing a reduction in mortality with the use of statins, "he said.

Statins reduce the risk of cancer

"In addition to interfering with the metabolism of cholesterol, they are also known as statins do things like" prison cell cycle progression, and induce cellular apoptosis ", which is programmed cell death. ApoptosisKnown as "programmed cell death"[1] (The correct definition is "cell death not followed by autolysis") is a type of "self-destructioncell"Which takes place in an orderly fashion and demand energy for its implementation (unlikenecrosis). It is related to the maintenance ofhomeostasis and the physiological regulation of the size of the tissue[2] But it can also be caused by a pathological stimuli (such as cellular DNA damage)[2] . The term is derived from the Greek, which meant the fall of the leaves of trees in autumn[3] - An example of physiological and appropriate programmed death that also involves renovation. Learn more apoptosis Cell

These two things are, in essence, the opposite of what happens in cancer, "said Jain.

In other words, statins can prevent the formation of cancer cells and can help eliminate cancer cells grow unchecked for apoptosis, which should have been done by a cellular "T-Killer". cancer_de_mama-300x238
Jain discussed the results of a study carried out byGalli and colleagueswhich included more than 5 thousand people living with HIV and a follow-up period of more than ten years. The study found that people in statin prescriptions were less likely to develop cancer: people who used statins tiberam a related experience câncerem a rate of 5,4 events by 1.000 person-years, and people not in use experienced cancer statins at a rate of 7,2 1.000 events per person-year. In general, the use of statins was estimated to reduce the risk of cancer 41%.

Disadvantages to the potential of statins

As with any medication, there is always the risk of side effects. Some people on statins have experiencedside effects on the cognitive partas confusion and forgetfulness, although so far this has not been well documented or categorized.

The risk of developing diabetes can increase in use of statins.

Diabetes can indeed be a consequence of HIV infection, especially when the person is undergoing treatment for HIV and antiretroviral use. Some may take on organically predisposed persons, the peripheral insulin resistance. I lived this situation when, God knows why, I began to eat like an elephant and my weight went up like a condor. Fortunately I made a gastroplasty (estômafo reduction) and the reduction of hunger, changes in appetite and eating habits and a healthier standard of living, my blood sugar dropped and mean it in blood tests is 73; so I could even stop drugs I used to control blood sugar. Nothing is impossible. I had the surgery with a weight of 147 kg, and now, three years later, my weight fluctuates between 89.5 and 92. Vis pacem to Belum

Diabetes can indeed be a consequence of HIV infection, especially when the person is undergoing treatment for HIV and antiretroviral use. Some may take on organically predisposed persons, the peripheral insulin resistance. I lived this situation when, God knows why, I began to eat like an elephant and my weight went up like a condor. Fortunately I made a gastroplasty (estômafo reduction) and the reduction of hunger, changes in appetite and eating habits and a healthier standard of living, my blood sugar dropped and mean it in blood tests is 73; so I could even stop drugs I used to control blood sugar. Nothing is impossible. I had the surgery with a weight of 147 kg, and now, three years later, my weight fluctuates between 89.5 and 92. Vis pacem to Belum

"I think it's not very likely a small, 5% to 10% to increased risk of diabetes with statin use. It is not clear whether it is specific to a statin or another - we do not know yet, "said Jain. People should not stop or discard statins why the diabetes risk exists, he said, but vendors need to be aware of this risk and monitor rigorously blood sugar levels in people taking a statin.
 
New research related to cholesterol and heart health for people living with HIV

New types of lipid-lowering drugs are called PCSK9 inhibitors. "PCSK9 inhibitors are an amazing success story of the basic science of disease," said Jain.

heart

Now, there are two drugs approved by the FDA: Praluent (alirocumab) and Repatha (evolocumab). They have been shown to dramatically reduce LDL levels in HIV-negative patients who take them. Studies with people living with HIV are in progress. So far, a study (pending publication) examined six people with HIV having evolocumab and demonstrated that there is a large reduction in LDL with treatment. But there must be more research to find out if this is true in studies with more people in the long term and there is also a reduced risk of cardiovascular events and death with these drugs.
March 31th 2016, PorEmily Newman Translated by CLaudio Souza Original in English:7 things people with HIV need to know about statins, LDL & heart healthby Claudio Souza
Claudio Souza - Seropositive from 1994

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About Claudio Souza do Soropositivo.Org (506 articles)
Yes, this is the photo of me! My niece asked me to put this picture on my profile! .... I had here a description of me that one person described as "irreverent". This is really a euphemistic way of classifying what was here. All I know is that an "NGO" which occupies a building of 10 floors has established a partnership with me, and I have the logs of the partnership time, which was more a vampirism because for each 150 people leaving my site, clicking on them, there was, on average, one that came in. WHEN I ENTERED AND ENTERED
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