Original paperStatins withdrawal, vascular complications, rebound effect and similitude
Section snippets
Material and methods
Literature was reviewed using the Medline database and the keywords ‘statin’, ‘rebound’ and ‘withdrawal’. The most relevant papers were selected and the scientific evidence discussed.
Primary action of statins
Statins are the most widely prescribed cholesterol-lowering drugs and are first-line therapeutic agents for the prevention of coronary heart disease and atherosclerosis (the major cause of death in developed countries). Statins act by inhibiting the enzyme 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase, the rate-limiting enzyme in endogenous cholesterol biosynthesis, which catalyses the reduction of HMG-CoA to mevalonic acid. Inhibition of this enzyme has proven to be effective for lowering
Discussion
Despite the numerous studies that demonstrate the primary vasculoprotective action of statins (pleiotropic effects), recent scientific evidence suggests that discontinuation of treatment results in a rapid (<7 days) return to endothelial dysfunction and amplification of the oxidative and inflammatory processes (rebound effects), increasing morbidity and mortality in patients with coronary artery and cerebrovascular diseases.
Experimental studies have described the physiological and molecular
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Similitude in modern pharmacology
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