Statin therapy needed for CVD prevention

Cardiovascular disease (CVD) is a life-long disease and requires a life-long treatment.

Such is the advice of heart experts as they discussed the role of the statin class of drugs in the treatment of cholesterol problems and other high-risk conditions which make patients prone to heart attacks and strokes, in this year’s annual convention of the Philippine College of Physicians.

Statins are now popularly prescribed to prevent cardiovascular problems. They work directly in the liver to block a substance needed to manufacture cholesterol. They also help the body remove cholesterol from arterial deposits, slowly unplugging blood vessels.

Dr. Esperanza Cabral, past president of the Philippine Heart Association and current president of the Philippine Society of Hypertension, explained that the atherosclerotic process, which clogs arteries, can be retarded but not actually cured or reversed effectively.

Atherosclerosis is a continuous, progressive and long-lasting process. In most cases, it is what we may call an incurable condition, but it can be helped, she added.

Since atherosclerosis is a life-long disease, it also requires life-long compliance to treatment. Cabral said physicians should advise their patients to take cholesterol-lowering drugs for an indefinite period of time. The cholesterol levels of those taking statins go down with treatment but after statin treatment is discontinued, the cholesterol levels go up again.

"You can bring the blood pressure down but in most instances, when you stop giving the patient anti-hypertensive agents, the blood pressure will go right back up again. The same is true with bad cholesterol levels and triglycerides," she said.

The other members of the panel of experts were Dr. Gregorio Patacsil Jr. and Dr. Rafael Castillo, both past presidents of the Philippine Heart Association. They also discussed the multiple clinical benefits which can be derived from statin therapy.

"These are benefits not necessarily associated with the statins’ cholesterol-lowering effect," said Patacsil. Statins are described to be versatile drugs, which also have the ability to prevent inflammation and blood clotting which are important factors in the atherosclerotic process.

The panel of experts, however, emphasized lifestyle changes as the important mainstay in treatment. It is no longer a secret that heart-related diseases such as hypertension, dyslipidemia and diabetes are caused by a bad diet and faulty lifestyle.

"There may be a genetic predisposition to the disease, but a major factor implicated in cardiovascular disease development is the individual’s lifestyle and diet," Patacsil said.

When lifestyle modification is not sufficient for those with cholesterol problems, doctors prescribe a cholesterol-lowering drug such as statins.

Studies using statins have reported 20 to 60 percent lower LDL-cholesterol level, which is the bad type of cholesterol, in patients using these drugs. Statins also reduce elevated levels of triglyceride (another unfavorable type of fat) and produce a modest increase in HDL-cholesterol (good cholesterol).

This class of drugs works by slowing down the production of cholesterol and by increasing the liver’s ability to remove the LDL-cholesterol already in the blood. Statins have become the drugs most often prescribed when a person needs a cholesterol-lowering medication.

Cabral also mentioned the results of the Heart Protection Study (HPS), which showed that vascular defects were significantly reduced in patients on statin therapy.

The benefits of statin therapy were sustained and even became greater with time. The HPS is the largest lipid lowering study involving 20,536 subjects, which determined whether or not statin therapy would reduce cardiovascular mortality and morbidity.

Treatment compliance has been a problem before for most patients since statins are relatively expensive. Addressing this patient compliance problem, Therapharma, a division of United Laboratories, has introduced an affordable brand of simvastatin (Vidastat), which is bio-equivalent with the more expensive brands. This move is seen not only to improve patient treatment compliance but also a means to help hypercholesterolemic patients increase their chances against the deadly CVD.