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

In: 2º half of 2016/Articles/heart/World Health Day/HIV/Ischemia

Blood cells and heartMost 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).

avc-removal-plate-300x240

"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.

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 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"[1] (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[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 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.

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% 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.

heart

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.

March 31th 2016, By Emily Newman

Translated by CLaudio Souza of the Original in English in: 7 things people with HIV need to know about statins, LDL & heart health by

Claudio Souza

Claudio Souza - Seropositive from 1994
That is the psycho-killer face

review by Mara Macedo

mara

tags:

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

Leave a Reply

Your email address Will not be published.

*

This site uses Akismet to reduce spam. Learn how your feedback data is processed.

The latest since:

We use cookies to give you the best online experience. By accepting the use of cookies in accordance with our cookie policy.

Go up Go To Top
%d Bloggers like this: