Most 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 receive statin drugs based on prescriptions to lower cholesterol levels in the blood. (A healthier diet and exercise can reduce cholesterol levels.) The most commonly prescribed statins are Lipitor (atorvastatin), Pravachol (pravastatin and rosuvastatin Crestor ().
Service providers has been used to decide whether or not a person should take statins based on their level of low density lipoprotein (LDL) cholesterol - particles that transport fat molecules to the cells and leading to construction cholesterol in the arteries. The latest guidelines say that statins are recommended, based on the fact that a person be at a foreseeable risk of cardiovascular events (such as heart attack or stroke -AVC).
"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.
He pointed to a study byMoore and colleagueswhich included 1.538 people with HIV who had suppressed viral loads to undetectable level, and and accompanied between 1998 and 2009. During this time there was 85 7 deaths of persons who were taking a statin and 78 people who were not taking a statin. The researchers estimated that statins reduced the risk of death by 67%.
Ina larger studyBy 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 over 3.500 patients, found a reduced risk of death, although the impact of statins on mortality was not statistically significant in their analysis.
"In general, I would say that the evidence that statins reduce mortality has not been as clear to people living with HIV than it has been for HIV-negative people. But do not seem to be a trend showing a reduction in mortality with statin use, "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" (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 But it can also be caused by a pathological stimuli (such as cellular DNA damage) . The term is derived from the Greek, which meant the fall of the leaves of trees in autumn - 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".
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.
"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.
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.
Translated by CLaudio Souza Original in English:7 things people with HIV need to know about statins, LDL & heart healthby
review by Mara Macedo