Table 8 Hypolipidaemic diet, lifestyle and drugs
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. |