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