Hypercholesterolemia, or high cholesterol, plays a key role in the development of atherosclerosis and the progression of coronary artery disease. Current guidelines indicate the importance of lowering LDL cholesterol to combat these effects. To achieve this goal, doctors often prescribe statins, which are drugs designed to inhibit the body's production of cholesterol. This often is very successful in regulating cholesterol levels.
Normal cholesterol metabolism
To control cholesterol, you need to control absorption or production. When you eat more cholesterol in your diet, you liver inhibits your body's production of the substance through an enzyme known as HMG-CoA reductase. When this enzyme detects elevated blood cholesterol its activity is diminished, resulting in decreased cholesterol synthesis in the liver.
Effects of Statins
According to the article "Advancing Therapy for Hypercholesterolemia" from Expert Opinion in Pharmacotherapy, HMG-CoA reductase acts as a crucial enzyme in cholesterol metabolism. As blood cholesterol levels fall, this enzyme's activity is increased, resulting in elevated cholesterol production by the liver. Statins act by inhibiting HMG-CoA reductase, thus cutting off this feedback pathway. The end result is a decrease in LDL or "bad" cholesterol and an increase in HDL or "good" cholesterol, which helps prevent progression of atherosclerosis.
Benefits of Reduced Cholesterol
Long term high cholesterol leads to accelerated development of atherosclerosis as well as its complications, including heart attacks and strokes. The excess cholesterol in your blood stream has a tendency to become oxidized by free radicals, resulting in the formation of a molecule capable of damaging blood vessel walls. These oxidized particles are commonly consumed by immune cells which accumulate in the walls of arteries, leading to vessel narrowing and further damage. Statins are useful in decreasing synthesis of circulating cholesterol, thereby preventing progression of vascular damage and atherosclerosis
Expert Insight
According to an article published in the JAMA, the ASTEROID trial has demonstrated the effectiveness of high intensity statin therapy in reducing the size of atherosclerotic plaques as measured by intravascular ultrasound. The researchers state that further investigations will have to be conducted to determine the effect of this therapy on clinical outcome, such as changes in rates of heart attack and stroke.
Warning
Statins are becoming widely popular in the treatment of high cholesterol, but there remains substantial controversy over the extent of their use. Talk to your doctor about the possible risks of statins. Statins are strictly contraindicated in patients who are pregnant or have a history of liver disease.
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