Elsevier

Homeopathy

Volume 99, Issue 4, October 2010, Pages 255-262
Homeopathy

Original paper
Statins withdrawal, vascular complications, rebound effect and similitude

https://doi.org/10.1016/j.homp.2010.01.001Get rights and content

Hahnemann considered the secondary action of medicines to be a law of nature and reviewed the conditions under which it occurs. It is closely related to the rebound effects observed with many modern drugs. I review the evidence of the rebound effect of statins that support the similitude principle. In view of their indications in primary and secondary prevention of cardiovascular diseases, statins are widely prescribed. Besides reducing cholesterol biosynthesis, they provide vasculoprotective effects (pleiotropic effects), including improvement of endothelial function, increased nitric oxide bioavailability, antioxidant properties, inhibition of inflammatory and thrombogenic responses, stabilisation of atherosclerotic plaques, and others. Recent studies suggest that suspension of statin treatment leads to a rebound imparing of vascular function, and increasing morbidity and mortality in patients with vascular diseases. Similarly to other classes of modern palliative drugs, this rebound effect is the same as a secondary action or vital reaction described by Samuel Hahnemann, and used in homeopathy in a therapeutic sense.

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

References (45)

  • H. Chen et al.

    Short-term withdrawal of simvastatin induces endothelial dysfunction in patients with coronary artery disease: a dose-response effect dependent on endothelial nitric oxide synthase

    Int J Cardiol

    (2009)
  • J.J. Li et al.

    Changes of plasma inflammatory markers after withdrawal of statin therapy in patients with hyperlipidemia

    Clin Chim Acta

    (2006)
  • A.C. Sposito et al.

    Rebound inflammatory response during the acute phase of myocardial infarction after simvastatin withdrawal

    Atherosclerosis

    (2009)
  • G.C. Fonarow et al.

    Effect of statin use within the first 24 hours of admission for acute myocardial infarction on early morbidity and mortality

    Am J Cardiol

    (2005)
  • O. Schouten et al.

    Effect of statin withdrawal on frequency of cardiac events after vascular surgery

    Am J Cardiol

    (2007)
  • E. Lesaffre et al.

    A retrospective analysis of the effect of noncompliance on time to first major adverse cardiac event in LIPS

    Clin Ther

    (2003)
  • P.M. Ridker et al.

    Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial

    Lancet

    (2009)
  • S. Hahnemann

    Organon of medicine

    (1991)
  • M.Z. Teixeira

    Semelhante cura semelhante: o princípio de cura homeopático fundamentado pela racionalidade médica e científica

    (1998)
  • Q. Zhou et al.

    Statins and cardiovascular diseases: from cholesterol lowering to pleiotropy

    Curr Pharm Des

    (2009)
  • J. Bełtowski et al.

    Adverse effects of statins – mechanisms and consequences

    Curr Drug Safety

    (2009 Sep 1)
  • M. Endres et al.

    Discontinuation of statin treatment in stroke patients

    Stroke

    (2006)
  • Cited by (0)

    View full text