Silent and, in most cases, without symptoms, high cholesterol is usually only identified during routine exams. Despite this, it is an important risk factor for cardiovascular diseases. When levels are high, especially LDL, known as “bad cholesterol”, there is an accumulation of fat on the walls of the arteries, favoring the formation of plaques that make it difficult for blood to pass through.

Over time, this process can compromise blood circulation and significantly increase the risk of serious problems, such as heart attack, stroke and thrombosis. According to endocrinologist Dr. Deborah Beranger, high cholesterol is usually related to both lifestyle habits and genetic predisposition.

“The causes of high cholesterol are excess alcohol, a sedentary lifestyle, a diet rich in fat and genetics. Most patients who are prone to high cholesterol have an important family history, with a father or mother also having the condition. Therefore, in the vast majority of cases, these patients will need medication at some point in their lives”, he explains.

It is in this context that statins come into play, medications widely used to reduce cholesterol levels and protect the cardiovascular system.

How do statins help reduce bad cholesterol?

According to pharmacist Dr. Maurizio Pupo, researcher and scientific director of IPUPO Post-Graduations, statins act directly on the production mechanism of cholesterol in the body. “Statins work by inhibiting an enzyme called hydroxymethylglutaryl coenzyme A reductase, which is the enzyme responsible for producing cholesterol in our body”, he explains.

By blocking this enzyme, medications mainly reduce LDL levels, the cholesterol associated with the formation of fatty plaques in the arteries. “When the enzyme hydroxymethylglutaryl coenzyme A reductase (HMG-CoA reductase) is reduced, cholesterol levels, and what matters to us is the bad LDL cholesterol, are automatically reduced as well”, he details.

Silent disease requires periodic exams

Vascular surgeon Dr. Aline Lamaita warns that, often, the first manifestation of high cholesterol occurs at an advanced stage. “The big problem with high blood cholesterol levels is that it is a silent problem: increased cholesterol may not cause any symptoms, clogging the arteries little by little. So, in some cases, the first manifestation of high cholesterol is an event such as a heart attack or stroke, when it is already too late to prevent it”, he highlights.

Therefore, regular medical monitoring is essential to monitor cholesterol levels in the body through blood tests. As it generally does not cause symptoms, periodic assessments make it possible to identify changes early and take measures to avoid complications.

Statins for the treatment of high cholesterol

Among the best-known statins for treating high cholesterol are rosuvastatin and atorvastatin. According to Dr. Maurizio Pupo, both have similar efficacy in terms of results, but with important differences in the duration of action and the patient’s profile.

“Rosuvastatin is a more modern drug, with greater potency to reduce hydroxymethylglutaryl coenzyme A reductase more quickly. Sometimes, within 15 days, the patient is already seeing a reduction in cholesterol. Atorvastatin, on the other hand, would take more or less 30 to 40 days to make this reduction”, he explains.

However, the pharmacist emphasizes that the choice of medication depends on the individual clinical condition. “It all depends on the cardiovascular risk. If the patient has a very high cardiovascular risk, sometimes it is necessary for the doctor to switch to a more potent drug in order to obtain a faster result”, he says.

When one or the other option may be the most appropriate

Dr. Maurizio Pupo explains that atorvastatin is often preferred in patients with chronic kidney disease or diabetes. “Atorvastatin is safer for kidney patients and also safer in relation to diabetesbecause it generally does not worsen the disease. Rosuvastatin can worsen both kidney disease and diabetes, although it reduces cholesterol in a shorter period of time”, he adds.

Another factor taken into consideration is the simultaneous use of several medications, a common situation in the elderly and chronic patients. “Rosuvastatin is less likely to interact with other medications because of the way it is metabolized. Atorvastatin can increase or decrease the plasma level of another medication when there is an interaction”, he adds.

Treatment goes beyond medication

Although statins are important tools for controlling cholesterol, experts reinforce that treatment also depends on changes in lifestyle, such as a balanced diet, regular physical activity and reducing alcohol and cigarette consumption.

According to Dr. Deborah Beranger, one of the main challenges is precisely adherence to continuous treatment. “We need to raise awareness of this patient, when he need medicationthat he cannot stop the medicine. Because, if he stops the medicine, his cholesterol will rise again. This is our biggest challenge, because, as it is a silent disease, the patient often stops taking medication when cholesterol reaches a normal level”, he states.

Dr. Aline Lamaita remembers that the intensity of treatment varies depending on each person’s cardiovascular risk. “Those who already have cholesterol levels above the recommended level should consult a doctor regularly, after all, the intensity of cholesterol control, with the use of medication or simply with the adoption of a balanced diet, depends on the cardiovascular risk of each individual, varying from case to case”, he concludes.

By Guilherme Zanette