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Table 8 Hypolipidaemic diet, lifestyle and drugs

From: Management of endocrino-metabolic dysfunctions after allogeneic hematopoietic stem cell transplantation

Dietary and life style guidance HMG-CoA reductase inhibitors (statins) Fibrates
- decrease the intake of saturated animal fat (e.g. meats, cheese, sauces and fried foods). - lower blood LDL-cholesterol levels by competitive inhibition of HMG coenzyme A decreasing liver synthesis of cholesterol - reduce triglyceride levels by 20-50%.
- favour omega-3 fatty acids (flaxseed, canola and walnut oil, wheat germ, soya, mackerel, herring, salmon…). - improve survival rates in adults with variable cholesterol levels (regardless of whether or not they have a history of coronary heart disease) - side effects:
- maintain a normal body weight and do adapted regular physical exercise - probably also beneficial in bone marrow recipients o gallstones, transit and muscle disorders.
- efficacy of rosuvastatin > atorvastatin (with the longest half-life) > simvastatin > pravastatin and fluvastatin (which are less expensive). o Risk increased in combination with a statin or with altered kidney function and with ciclosporine.
- statins other than fluva-, prava- and rosuvastatin, are metabolized by cytochrome P450 (or CYP3A4) - Fenofibrate preferred to gemfibrozil because of fewer side effects, although it can sometimes increase creatinine levels.
- can thus interfere with many drugs*, calcineurin and mTOR inhibitors, methotrexate, cimetidine, grapefruit juice.
- CYP3A4 inhibitors should be avoided in combination with calcineurin inhibitors and statins
- Statins have liver, muscle toxicity: high-dose (>80 mg) statins must not be prescribed.
  1. *Main CYP3A4 inhibitors: calcium-blockers (diltiazem, verapamil), macrolides (erythromycin, clarithromycin), azole antifungals (itraco- and keto-conazole), antivirals (rito-, indi-, nelfi- and ampe-navir).