Statins save lives. Dr. Krzysztof Chlebus talks about effective cholesterol reduction with “Wprost”.

As pointed out by Dr. Krzysztof Chlebus, founder of the National Center for Familial Hypercholesterolemia in Gdansk and coordinator of the National Register for the collection of data from patients with this disease, in studies at the level of the so-called. In terms of bad cholesterol in the blood, we are worse than Western European countries, and also worse than Scandinavia, which is close to us in terms of nutrition. According to the specialist, this is due to the fact that we have a higher level of risk factors for the disease. Poles’ high cholesterol levels are influenced by genetics, as well as lifestyle, diet, smoking, and physical inactivity.

How to interpret cholesterol tests?

Cholesterol is essential for the proper functioning of the body. It is contained in the composition of cell membranes (including nerve cells), and is also part of bile. Takes part in the synthesis of vitamin D3, testosterone, progesterone, estrogen and corticosteroids. It plays an important role in the metabolic processes occurring in the brain. However, if a large amount of cholesterol circulates in the vessels, this significantly increases the risk of developing atherosclerosis, and therefore a heart attack or stroke, and therefore death because of this, explains Dr. Khlebus. And adds:

It must be remembered that when taking treatment, we are fighting only with the cholesterol that circulates in our blood, and not with all the cholesterol that is in the body and that it needs.

As the specialist explains, there is too much anxiety in deciphering cholesterol tests that are carried out from the blood. high levels of LDL, the so-called. bad cholesterol And total cholesterol. However, there is no upper limit for HDL cholesterol, higher levels of which are considered beneficial to health.

Cholesterol-lowering therapy should be based on an individual assessment of the patient’s cardiovascular risk. Especially in high-risk patients, we aim to achieve a significant reduction in LDL cholesterol levels. We avoid saying what kind of cholesterol we are treating, we rather say what it should be, referring to the specific situation of the patient, if we want to reduce the risk of a heart attack or stroke, says Dr. Khlebus.

To what level should cholesterol levels be reduced and how long should therapy continue?

Dr. Chlebus notes that the current discussion in the medical community is mostly about how much to lower LDL cholesterol because it seems obvious that it should be lowered. The duration of therapy is always long, since only a constant decrease in LDL levels gives the expected results. Therapy should continue as long as we want to reduce the risk of stroke and heart attack. It is effective and safe, although there is a group of patients who are afraid of treatment.

In the past, LDL cholesterol levels have been reduced to less than 100 mg/dm3. Then the benefit of lowering it below 70 mg/dm3 began to be noticed. Today, we know that dropping below 50 brings additional health benefits, and the cardiovascular event curve is greatly reduced. Recent studies suggest that cholesterol reduction should be below 40 mg/dL, says Dr. Khlebus.

As the expert explains, such conclusions are drawn, among other things, from observation of patients who have a genetically determined very low level of cholesterol in the blood. This is due to a mutation in the PCSK9 gene. Such people are born and live with very low levels of LDL cholesterol: just a few mg / dcm, which was once considered “undetectable”. Studies show that they do not develop cardiovascular disease, heart attacks or strokes. The results are confirmed already in the next generation of observed patients.

Why are some patients concerned about lowering cholesterol with medication?

Statins are the most commonly used therapy to lower “bad” cholesterol (LDL). Doses of drugs are selected individually, depending on how the patient responds to the drugs, i.e. how quickly the goal of lowering cholesterol is achieved. Research confirms that statins are effective and relatively safe, contrary to popular belief. They are also available for most patients. In Poland, patients have been treated with statins for 40 years, the expert explains.

Statins should be used at the doses prescribed by your doctor. Irregular medication in too small doses can be only a patch on the conscience, not an effective treatment, Dr. Khlebus warns.

Some patients report side effects after taking statins. However, numerous studies have shown that the negative effects of statins occur in 90 percent of cases. the so-called nocebo effect. They boil down to the fact that if we know that such ailments exist, we will feel them. However, this has nothing to do with the effect of the drug, explains Dr. Khlebus. On this basis, patients often drop out of therapy. Doctors believe that this is very unfavorable, because patients are deprived of a chance for treatment and life. As the expert points out, the motivation for taking medications in patients, for example, after a heart attack, is also different from that of people who have undergone preventive treatment and have not experienced such events. Patients after a heart attack treat this drug as a “blessing” and do not think about whether something hurts after taking it, because they know that without the drug they can die. Even if they feel some discomfort after taking the drug, such as pain in the calves, due to the level of safety offered by the drugs, they are reluctant to stop taking it.

Don’t be afraid of statin treatment

The statistics on the incidence of heart attacks and strokes before the introduction of statin treatment in the 1970s and 1980s undeniably show how many more people died when we did not have access to statins, what was the death rate from heart attacks and morbidity. heart attacks in Poland. Since the 1990s, when statin treatment was introduced, the statistics have continued to improve. The expert notes that the higher doses of statins used to treat too high cholesterol in the general population, the better these results.

Statins save lives. In 40 percent reduce the risk of heart attack or stroke. Ischemic stroke more than 20%. So, if you compare diseases and risks on a scale, it becomes clear that the benefits of treatment are greater than the possible side effects, says Dr. Khlebus.