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Statine

Vreau s v vorbesc despre o problem de sntate foarte serio n America. Pentrumilioane de oameni, medicii prescriu o clas de medicamente numite statine (Lipantil,Crestor, etc.). Se presupune c acestea reduc colesterolul i, in consecin , previnatacurile de cord. !ar eu v spun ceva ce ave i dreptul s ti i despre acest tip demedicamente. "nt#i de toate$ Scad ele colesterolul% &spunsul este da, l scad. !ar iat ontrebare mai important$ previn ele infarctul miocardic% &spunsul este nu, nu'l previn.Sunt ele si ure% u, nu sunt. !eci dac iei statine, iei un medicament pentru a'ti preveniun eventul infarct i care, de fapt, mu'l previne. *ai mult, iei un medicament care nu estesi ur, adic i poate face ru. Are asta vreo lo ic% !e fapt medicamentul tu pe ba+ destatine te pune ntr'un pericol foarte mare, pre tind terenul pentru pentru boli de inim ialte afec iuni rave, inclu+#nd o boal de rinic i letal.

Avnd n vedere c statinele sunt complet nefolositoare i periculoase, de ce sunt prescrise% -i bine, cei mai mul i medici cred c un nivel ridicat de colesterol este principala cau+ a bolilor cardiace i vd statinele sunt complet nefolositoare i periculoase, dece sunt prescrise% -i bine, cei mai mul i medici cred c un nivel ridicat decolesterol este principala cau+ a bolilor cardiace i vd statinele ca pe nite medicamentesalvatoare de vie i. Aceast lo ic este fundamental reit. !ac colesterolul contea+aa de mult n apari ia bolilor cardiace, cum v e plica i c cei mai mul i oameni care facinfarct au un nivel al colesterolului perfect normal% !e fapt este e act invers$ riscul deinfarct crete la cei care iau statine. Prin urmare, statinele cau+ea+ boli de inim./n doctor care pre+int n mod cura0os despre pericolul statinelor este cardiolo ul!r.Peter Lan s0oen (1,2), care ntr'o peti ie adresat 3!A (a en ia S/A responsabil cu

introducerea pe pia a medicamentelor) a scris, cite+, 4statinele pre0udicia+ ravsntatea oamenilor i pe mul i i omoar5. 6o i pacian ii care iau statine devin deficien in coen+ima 718 ntr'un interval de 9'12 luni (:). Persoanele tinere i sntoase pot tolerastatinele c# iva ani nainte de a ncepe neca+urile, ca oboseala, slbiciunile, durerimusculare i, n final, afec uni cardiace.Statinele sunt prescrise cu o uurin de nedescris, n concentra ii din ce n ce mai mari,nu numai oamenilor n v#rst, ci i oamenilor ce au colesterolul normal, numai n ideeade a preveni o boal cardiac, dei nu au aceat calitate. Adevarul este c bolile de inimi infarcturile sunt din ce n ce mai numeroase ca re+ultat al administrrii de statine. Aaprut c iar o boal nou denumit, cardiomiopatie statinic. Suntem n pre+entmartoriiuneia dintre cele mai mari tra edii ale timpului nostru. iciodat n istorie,tiim a medical nu a mai creat, cu bun tiin , un medicament care s amenin e via a amilioane de oameni, de altfel sntoi, aa cum se nt#mpl acum cu statinele. Statineleafectea+ esutul muscular, provoc#nd dureri permanente i slbiciune. /n studiu din2818 publicat n reistaCurrent Atherosclerosis Reports afirm c 1;< dintre consumatoride statine acu+ probleme musculare. *ai mult, esutul muscular afectat produce o protein numit mio lobin, care se descompune ntr'o substan c imic ce perturbactivitatea rinic ilor i cau+ea+ o boal fatal numit, rabdomioli+. Alte complica iiinclud, tulburri de coa ulare i stop cardiac.

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Statinele distru ficatul, d#nd dureri abdominale, urini nc ise la culoare, n lbenirea pielii i a scleroticii, ca semne ale afectrii serioase ale acestui or an.Statinele perturb sistemul nervos. europatia periferic cau+at de statine este tradus prin simptome precum, furnicturi i tresriri necontrolate ale m#inilor i picioarelor, care pot escalada p#n la sen+a ii dureroase de aresur i parali+ia membrelor. C iar i atunci

cnd sunt luate n do+e relativ mici, statinele cau+ea+ o reducere a func iilor motorii cu=8< fa de cei ce nu iau statine.Statinele ac ionea+ nefast asupra creierului cau+#nd pierderi de memorie, confu+ie(simtome similare bolii Al+ eimer), sc imbri brute de dispo+i ie, depresie, ostilitatea resivitate.!iabetul este o alt complica ie. /n studiu al cercettorilor de la >arvard publicat inianuarie 2812 a conclu+ionat c, folosirea pe termen lun a statinelor, crete probabilitatea de+voltrii unui diabet +a arat de tip ?? cu cca ;8*@'CoA reductase in ibitors. *ol Aspects *ed 1HH , 1FSuppl$S 1: '1==.=.Collins & , Armita e D, Paris S, Slei P, Peto & . *&CIJ>3 >eart Protection StudB ofc olesterol'loGerin Git simvastatin in ;H9: people Git diabetes$ a randomised placebo'controlled trial.Lancet. 288: Dun 1=E:91(H: =)$288;'19.-pub 288; Dul ;.;. 6onelli * , ?sles C, Craven 6,et al. -ffect of pravastatin on rate of idneB function lossin people Git or at ris for coronarB disease Circulation. 12E112(2)$1 1'F, 288;.9. &avi V, S a *!, Allison J, @oldfine *!. Statins and ris of neG'onset diabetesmellitus.Circulation, 129$e2F2'2F=, 2812

.Palmer SC , Craig JC , Navaneethan SD , Tonelli M , Pellegrini F , Strippoli GF . Jenefits andarms of statin t erapB for persons Git c ronic idneB disease$ a sBstematic revieG andmeta'analBsis. Ann ?ntern *ed1; (=)$29:' ;. doi$ 18. :29I888:'=F1H'1; '='28128F218'8888 , 2812.

8. *iBa eK,S ou+u A, is i aGa *B Konemoto 6, S imi+u >, moto S, >aBa aGa 6, ?nada *. -ffectof treatment Git : ' Bdro B': 'met Bl lutarBl coen+Bme A reductase in ibitors on serum coen+Bme 7lo indiabetic patients. Ar+neimittelforsc un 1HHH AprE=H(=)$:2='H.

http://www.ncbi.nlm.nih.gov/pubmed?term=Littarru%20GP%5BAuthor%5D&cauthor=true&cauthor_uid=17482884http://www.ncbi.nlm.nih.gov/pubmed?term=Langsjoen%20P%5BAuthor%5D&cauthor=true&cauthor_uid=17482884http://www.ncbi.nlm.nih.gov/pubmed/17482884http://www.ncbi.nlm.nih.gov/pubmed?term=Collins%20R%5BAuthor%5D&cauthor=true&cauthor_uid=12814710http://www.ncbi.nlm.nih.gov/pubmed?term=Armitage%20J%5BAuthor%5D&cauthor=true&cauthor_uid=12814710http://www.ncbi.nlm.nih.gov/pubmed?term=Parish%20S%5BAuthor%5D&cauthor=true&cauthor_uid=12814710http://www.ncbi.nlm.nih.gov/pubmed?term=Sleigh%20P%5BAuthor%5D&cauthor=true&cauthor_uid=12814710http://www.ncbi.nlm.nih.gov/pubmed?term=Peto%20R%5BAuthor%5D&cauthor=true&cauthor_uid=12814710http://www.ncbi.nlm.nih.gov/pubmed?term=Peto%20R%5BAuthor%5D&cauthor=true&cauthor_uid=12814710http://www.ncbi.nlm.nih.gov/pubmed?term=12814710http://www.ncbi.nlm.nih.gov/pubmed?term=Tonelli%20M%5BAuthor%5D&cauthor=true&cauthor_uid=15998677http://www.ncbi.nlm.nih.gov/pubmed?term=Isles%20C%5BAuthor%5D&cauthor=true&cauthor_uid=15998677http://www.ncbi.nlm.nih.gov/pubmed?term=Craven%20T%5BAuthor%5D&cauthor=true&cauthor_uid=15998677http://www.ncbi.nlm.nih.gov/pubmed?term=15998677http://www.ncbi.nlm.nih.gov/pubmed?term=Palmer%20SC%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Craig%20JC%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Craig%20JC%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Craig%20JC%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Navaneethan%20SD%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Navaneethan%20SD%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Tonelli%20M%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Pellegrini%20F%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Pellegrini%20F%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Pellegrini%20F%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Strippoli%20GF%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Strippoli%20GF%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Littarru%20GP%5BAuthor%5D&cauthor=true&cauthor_uid=17482884http://www.ncbi.nlm.nih.gov/pubmed?term=Langsjoen%20P%5BAuthor%5D&cauthor=true&cauthor_uid=17482884http://www.ncbi.nlm.nih.gov/pubmed/17482884http://www.ncbi.nlm.nih.gov/pubmed?term=Collins%20R%5BAuthor%5D&cauthor=true&cauthor_uid=12814710http://www.ncbi.nlm.nih.gov/pubmed?term=Armitage%20J%5BAuthor%5D&cauthor=true&cauthor_uid=12814710http://www.ncbi.nlm.nih.gov/pubmed?term=Parish%20S%5BAuthor%5D&cauthor=true&cauthor_uid=12814710http://www.ncbi.nlm.nih.gov/pubmed?term=Sleigh%20P%5BAuthor%5D&cauthor=true&cauthor_uid=12814710http://www.ncbi.nlm.nih.gov/pubmed?term=Peto%20R%5BAuthor%5D&cauthor=true&cauthor_uid=12814710http://www.ncbi.nlm.nih.gov/pubmed?term=12814710http://www.ncbi.nlm.nih.gov/pubmed?term=Tonelli%20M%5BAuthor%5D&cauthor=true&cauthor_uid=15998677http://www.ncbi.nlm.nih.gov/pubmed?term=Isles%20C%5BAuthor%5D&cauthor=true&cauthor_uid=15998677http://www.ncbi.nlm.nih.gov/pubmed?term=Craven%20T%5BAuthor%5D&cauthor=true&cauthor_uid=15998677http://www.ncbi.nlm.nih.gov/pubmed?term=15998677http://www.ncbi.nlm.nih.gov/pubmed?term=Palmer%20SC%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Craig%20JC%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Navaneethan%20SD%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Tonelli%20M%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Pellegrini%20F%5BAuthor%5D&cauthor=true&cauthor_uid=22910937http://www.ncbi.nlm.nih.gov/pubmed?term=Strippoli%20GF%5BAuthor%5D&cauthor=true&cauthor_uid=22910937

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Statins are dru s of noGn and undisputed efficacB in t e treatment ofBperc olesterolemia, usuallB Gell tolerated bB most patients. ?n some cases treatment

Git statins produces s eletal muscle complaints, andIor mild serum CM elevationE t e

incidence of r abdomBolBsis is verB loG. As a result of t e common biosBnt etic pat GaBCoen+Bme 7 (ubiNuinone) and dolic ol levels are also affected, to a certain de ree, bBt e treatment Git t ese >*@'CoA reductase in ibitors. Plasma levels of Co718 areloGered in t e course of statin treatment. 6 is could be related to t e fact t at statinsloGer plasma L!L levels, and Co718 is mainlB transported bB L!L, but a decrease isalso found in platelets and in lBmp ocBtes of statin treated patients, t erefore it couldtrulB depend on in ibition of Co718 sBnt esis. 6 ere are also some indications t at statintreatment affects muscle ubiNuinone levels, alt ou it is not Bet clear to G ic e tentt is depends on some effect on mitoc ondrial bio enesis. Some papers indicate t atCo718 depletion durin statin t erapB mi t be associated Git subclinicalcardiomBopat B and t is situation is reversed upon Co718 treatment. Oe can reasonablB

Bpot esi+e t at in some conditions G ere ot er Co718 depletin situations e isttreatment Git statins maB seriouslB impair plasma and possible tissue levels ofcoen+Bme 718. O ile Gaitin for a lar e scale clinical trial G ere patients treated Gitstatins are also monitored for t eir Co718 status, Git a roup also bein iven Co718, p Bsicians s ould be aGare of t is dru 'nutrient interaction and be vi ilant to t e possibilitB t at statin dru s maB, in some cases, impair s eletal muscle and mBocardial bioener etics.

?ndividuals Git diabetes are at increased ris of cardiovascular morbiditB and mortalitB,alt ou tBpicallB t eir plasma concentrations of L!L c olesterol are similar to t ose int e eneral population. Previous evidence about t e effects of loGerin c olesterol in people Git diabetes as been limited, and most diabetic patients do not currentlB receivec olesterol'loGerin t erapB despite t eir increased ris .

METHODS:

;H9: /M adults (a ed =8'F8 Bears) noGn to ave diabetes, and an additional 1=; : Gitocclusive arterial disease (but no dia nosed diabetes), Gere randomlB allocated to receive=8 m simvastatin dailB or matc in placebo. Prespecified analBses in t ese prior diseasesubcate ories, and ot er relevant subcate ories, Gere of first ma0or coronarB event (ie,non'fatal mBocardial infarction or coronarB deat ) and of first ma0or vascular event (ie,ma0or coronarB event, stro e or revascularisation). AnalBses Gere also conducted of

subseNuent vascular events durin t e sc eduled treatment period. Comparisons are of allsimvastatin'allocated versus all placebo'allocated participants (ie, intention to treat),G ic Bielded an avera e difference in L!L c olesterol of 1.8 mmolIL (:H m IdL)durin t e ;'Bear treatment period.

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FINDINGS:

Jot amon t e participants G o presented Git diabetes and amon t ose G o did not,t ere Gere i lB si nificant reductions of about a Nuarter in t e first event rate for ma0ocoronarB events, for stro es, and for revascularisations. 3or t e first occurrence of anB of

t ese ma0or vascular events amon participants Git diabetes, t ere Gas a definite 22*@'CoA reductase in ibitors (statins) reduce rates of idneB

function loss. Oe performed t is analBsis to determine G et er pravastatin reduced t erate of idneB function loss over appro imatelB ; Bears in people Git or at i ris forcoronarB disease.

METHODS AND RESULTS:

6 is Gas a post oc sub roup analBsis of data from : randomi+ed double'blind controlledtrials comparin pravastatin =8 m Id and placebo in sub0ects Git a previous acute

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DATA EXTRACTION:

6Go independent revieGers e tracted data and assessed ris of bias.

DATA SYNTHESIS:

-i tB trials comprisin ;18HH participants compared statin Git placebo or no treatment.6reatment effects varied Git sta e of CM!. *oderate' to i 'NualitB evidenceindicated t at statins reduced all'cause mortalitB (relative ris &&Q, 8.F1 H;< C?, 8. =to 8.FFQ), cardiovascular mortalitB (&&, 8. F C?, 8.9F to 8.FHQ), and cardiovascularevents (&&, 8. 9 C?, 8. : to 8.F8Q) in persons not receivin dialBsis. *oderate' to i 'NualitB evidence indicated t at statins ad little or no effect on all'cause mortalitB (&&,8.H9 C?, 8.FF to 1.8=Q), cardiovascular mortalitB (&&, 8.H= C?, 8.F2 to 1.8 Q), orcardiovascular events (&&, 8.H; C?, 8.F to 1.8:Q) in persons receivin dialBsis. -ffectsof statins in idneB transplant recipients Gere uncertain. Statins ad little or no effect oncancer, mBal ia, liver function, or Git draGal from treatment, alt ou adverse eventsGere evaluated sBstematicallB in feGer t an alf of t e trials.LIMITATION:

6 ere Gas a reliance on post oc sub roup data for earlier sta es of CM!.

CONCLUSION:

Statins decrease mortalitB and cardiovascular events in persons Git earlB sta es of CM!,ave little or no effect in persons receivin dialBsis, and ave uncertain effects in idneB

transplant recipients.