Which statin is the ideal statin for polymedicated patients?

  • Borghi C
  • Cicero A
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Statins are used widely for the treatment of cardiovascular (CV) disease
because they improve the lipid profile and reduce the rate of coronary
and cerebrovascular diseases. During the past 15 years, the overall risk
profile of patients treated with statins has changed considerably,
becoming more complex due to a progressive increase in the proportion of
subjects with several concomitant diseases. Indeed, the presence of
dyslipidemia is frequently associated with arterial hypertension,
diabetes and the metabolic syndrome, as well as with CV and renal
disease. In this patient population, the ideal statin should bear some
properties that allow for both a substantial improvement in the lipid
profile and a reduction in global CV risk. In particular, the ideal
statin should provide both a reduction in total and LDL-C and an
increase in HDL-C, effects that have been described for statins such as
pitavastatin. The clinical efficacy of the ideal statin should be
confirmed in a large population of patients and across a wide range of
CV risk profiles, ranging from primary to secondary prevention. The
ideal statin should be effective in patients in whom dyslipidemia and
additional metabolic risk factors (e.g., abnormal glycemic control and
metabolic syndrome) coexist. In such patients, a detrimental activation
of tissue renin-angiotensin occurs that can be down-regulated with
statin treatment. From the safety perspective, the ideal statin should
be characterized by a low risk of drug-drug interactions, the incidence
of which is significantly increased in polymedicated patients. Unlike
other statins, pitavastatin does not undergo cytochrome P450 3A4
metabolism and, therefore, demonstrates a low potential for drug-drug
interactions. Recently, treatment with pitavastatin has been associated
with an improvement in cardio-renal function (improvement of diastolic
function and reduced proteinuria). This might contribute to reduce the
CV risk in addition to lipid control, the actual target for modern,
effective lipid-lowering treatments.

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  • Claudio Borghi

  • Arrigo FG Cicero

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