[Prevention of coronary heart disease with statins. Which patients profit?].
Statins are generally considered as safe drugs with a very favorable cost-efficacy-ratio. Calculation of health expenses limits the prescription of statins in primary prevention to persons on high risk (i.e. 20% risk of a coronary infarction within the next 10 years). Prescription of statins in secondary prevention of atherosclerosis is mandatory. Advanced age, impairment of renal function or polypharmacotherapy increase the incidence of severe side-effects, especially myopathy and rhabdomyolysis. These patients should be given statins with lesser risk of these side-effects. Combination of statins with fibrates has attracted public concern, but may be indicated in persons with otherwise not treatable hyperlipidemia. These patients need intensive monitoring, just as patients on other drugs that are metabolized via the enzyme CYP3A4. Patients on statins should get dietary counseling, as an appropriate diet increases the effect of statins.
Adam
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O
Walther-Straub-Institut für Pharmakologie und Toxikologie der LMU München. olaf.adam@lrz.uni-muenchen.de
Forth
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W
D000924:Anticholesteremic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003327:Coronary Disease / Q000517:prevention & control*; D005858:Germany; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy; D009203:Myocardial Infarction / Q000517:prevention & control; D010342:Patient Acceptance of Health Care; D055502:Secondary Prevention
D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors