Most people had a blood test called a "lipid" panel made when they went in for consultation with their doctor. Have you ever wondered why yours does these tests and what they look for? And if you're already taking a drug like Lipitor, did you know that besides lowering your cholesterol, it could also be preventing cancer? Vivek Jain, MD, but an assistant professor of medicine in the HIV / AIDS division at San Francisco General Hospital, shared his experience on LDL cholesterol, statins, and the latest heart health research for people living with HIV in a recent presentation rounds at the Grand San Francisco General Hospital HIV / AIDS. Here is 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 have been used to decide whether or not a person should take statins based on their low-density lipoprotein (LDL) cholesterol - particles that carry the fat molecules to the cells and that lead to construction of cholesterol in the arteries. The most recent guidelines state that statins are recommended based on whether a person is at a predictable risk of cardiovascular events (such as heart attack or stroke).
"At the end of 2013, the new American Heart Association and the American College of Cardiology the new guideline came out. You get a "global" risk prediction score that gives you a ten-year risk of a cardiovascular event. Statins are recommended when the ten-year risk is more than 7,5%, and 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're trying to stay away from LDL targets and move toward risk goals."
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 statins, including 616 people living with HIV and 5.451 people who were HIV negative, found a significant difference in the percentage of LDL reduction 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 the current study between HIV-negative and HIV-positive patients was statistically significant, Jain explained.
This closed loophole, however, for people with HIV using atorvastatin - the most frequently prescribed and most potent statin who experienced a drop in LDL levels that was not significantly different from the decline seen 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 no issue to worry about," Jain said.
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 by Moore and colleagues which 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%.
Em a 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-destruction cell"Which occurs in an orderly manner and demands energy for its execution (unlike necrosis). It is related to the maintenance of homeostasis 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 by the Galli and colleagues which included more than 5 thousand people living with HIV and a follow-up period of more than ten years. The study found that people under statins prescriptions were less likely to develop cancer: people who used statin drugs had a cancer-related experience at a rate of 5,4 events per 1.000 person-years, and people not in use of statin experienced cancer at a rate of 7,2 events per 1.000 people-year. In general, the use of statins was estimated to reduce the risk of cancer by 41%.
Disadvantages to the potential of statins
As with any medication, there is always the risk of side effects. Some people on statins have experienced side effects on the cognitive part such as 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% increase in the risk of diabetes with the use of statins. It's unclear if it's specific to one statin or another - we do not know yet, "Jain said. People should not stop or rule out statins because the risk of diabetes exists, he said, but providers need to be aware of this risk and closely monitor 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 drastically reduce LDL levels in HIV-negative patients who take them. Studies with people living with HIV are ongoing. So far, one study (pending publication) has examined six people with HIV taking evolocumab and has shown that there is a large reduction of LDL with treatment. But there has to be more research to find out if this is true in studies with more people in the long term and whether there is also a reduced risk of cardiovascular events and deaths with these drugs.
Translated by CLaudio Souza of the Original in English in: 7 things people with HIV need to know about statins, LDL & heart health by
review by Mara Macedo