Mexico City.- In a country like Mexico, where heart diseases are the first cause of death, getting risk patients to lower their cholesterol levels is a daily clinical challenge.
If in the past the pharmacological strategy relied on receiving high doses of statins -a type of medication that reduces the amount of cholesterol produced by the liver, helping to eliminate what already circulates through the blood-, the current paradigm consists in the use of more effective combinations.
Compounds like the one that a group of specialists in Mexico evaluated through a clinical study in which 103 patients with dyslipidemia participated, that is, with high concentrations of lipids -cholesterol, triglycerides or both-, whose favorable results were published last September in the medical journal Cardiology Research and Practice.
“We started inviting people to participate in this study in September 2020, in the second wave of the pandemic. And the results we observed were truly remarkable”, says Joel Rodríguez Saldaña, director of the Multidisciplinary Diabetes Center (Cemudi) in an interview. ).
The formula used during the four months that lasted the protocol was the combination -in a tablet developed by the Mexican pharmaceutical Laboratorios Silanes- of the statin called rosuvastatin with the drug ezetimibe, also belonging to the so-called cholesterol reducers that can act by preventing its absorption in the intestine.
“The ezetimiba what it does is to act on a machinery that have the cells of the intestine to absorb the cholesterol”, refrenda Rodríguez Saldaña.
“This highly valued compound therefore acted on cholesterol levels in two ways: preventing it from being produced in harmful amounts in the liver (through rosuvastatin), and reducing its absorption in the intestine”.
As the expert expresses it, the result of this was very positive, putting 94 percent of the participants -of those who married mitad, 48 percent, were of high cardiovascular risk, and 22 percent, of very high riesgo- achieved total cholesterol control, keeping it below 200 milligrams per deciliter of blood (mg/dL), as recommended.
But that’s just it, I mean a marked decrease in the so-called bad cholesterol, the cholesterol carried by low-density lipoproteins (LDL, by its acronym in English), which international guides recommend that it be at a level lower than 75 mg /dL, which was the goal of that studio.
In this way, 72 percent of the participants -people with obesity, diabetes and hypertension- achieved their goals in a short time, and even after four months of treatment their LDL cholesterol was maintained at levels of 51 mg/dL.
“(This formula) represents the opportunity to reduce the plaque load, which is the medical name given to the parsimonious accumulation of cholesterol for decades”, explains Rodríguez Saldaña.
“This drug, among all statins, is the one that has the evidence of developing benefits in the shortest time on part of the plaque load”.
The importance of this is rooted in that the accumulation of many plaques of fatty material -a disorder known as atherosclerosis-, while affecting the arteries that irrigate the heart and the brain, increases the risk of suffering a myocardial infarction or a cerebrovascular accident.
This is why Rodríguez Saldaña considers that the public health consequences for the extended use of this combination of fixed doses of rosuvastatin and ezetimibe -available since two years ago- “are extraordinary”.
Asked about the possible adverse effects or contraindication for certain types of patients, the specialist details that in the hubo suspensions of the treatment for some of these reasons. Although it is not obvious the fact that for some years it has been observed that statins can cause muscle discomfort in some people.
“But the use of these drugs for decades has shown that they are extraordinarily effective, that cases (of muscle pain) are very rare; and, actually, last year a report was published that demonstrated that there is a very rare genetic predisposition to to develop adverse effects”, sustains Rodríguez Saldaña.
“The cost-benefit ratio of the drug in light of its effectiveness in laboratory tests, and the perspective of being able to use it for years to improve people’s safety and reduce what we know as plaque burden, these are arguments all to Please,” he insists.
Tracking in time
Fully confident in the results he had witnessed first hand, Rodríguez Saldaña continues to receive this combination for those who come to the consultation.
I did this, for example, with a 44-year-old man with diabetes who had a cholesterol level of 216 milligrams (mg/dl) during a fever.
“After two months of treatment, this man had a total cholesterol of 111 mg/dl; the triglycerides, which were at 264 mg/dl, still had them at 76 mg/dl, and the low density cholesterol, which he had at 135 mg/dl, below at 55 mg/dl”, shares the director of Cemudi, who for decades has participated in around 50 clinical studies.
“The lord was happy, his wife too, they were very happy”, continues the doctor. “These are results from the real world, people who are out there, who work in this City, and who only confirmed to us that this combination is an extraordinary synergism with tremendous benefits for health”.
However, Rodríguez Saldaña points out that the benefits of treatment for this type of lipid disorder are demonstrated only after years of administration.
“In the real world, in clinical practice, the people who manage to survive so as not to suffer a heart attack or not to have it again are the ones who continue to take these drugs indefinitely”, he explains.
This is why, until the study is finished and the results published, the doctor assures that he will continue with the follow-up of those who have taken the compound of rosuvastatin and ezetimibe.
“Last week, a young man went to the consultation for the same topic. Iba with his girlfriend, she told us that she was very interested in this person taking the medicine because she participated in the studio and he found that he had gone very well.
“So we decided to continue using it. The evidence on its effectiveness is remarkable, and its safety is extraordinary; we have no reason to look for another alternative, and we have continued using it”, reiterates the doctor.
Finally, Rodríguez Saldaña is emphatic that despite having this pharmacological option, this does not replace the need to control cholesterol levels through healthy lifestyle habits.
“The benefits of these drugs occur in the person indicated. And the person indicated is the one who makes changes in their lifestyle, respects food, exercises, quits smoking and tries to reduce stress, which is a task every time more difficult”, señala.
“We are what we eat, and food is a very important part of control”, he concluded.
How to take care?
Some risk factors for having a high cholesterol level, and with it a high risk of complications such as atherosclerosis, are:
– food bag
Foods low in calories and saturated and hydrogenated or “trans” fats must be chosen.
-Obesity
Having a body mass index (BMI) of 30 or more increases the risk of having high cholesterol.
-Lack of exercise Physical activity helps to increase the so-called good cholesterol cholesterol and decrease the size of bad cholesterol particles.
-Smoking
Smoking damages the walls of blood vessels and makes them more likely to accumulate grease deposits.
-Diabetes
A high blood sugar level contributes to higher levels of dangerous cholesterol and lowers good cholesterol. The high level of sugar in the blood also damages the lining of the arteries.
