Bachelor Science of Human Nutrition "
" Pharmacology "Professor Raimondi
report Simona Sampirisi
Cholesterol is a lipid molecule sterol, but not a fatty alcohol is due to the presence of the hydroxyl group in position 5 '. E 'typical animal organisms, especially of vertebrates and is present in all tissues and in greater quantities in the brain, bile and blood. Cholesterol is a major component (~ 20%) of the "Cell membrane: its importance is due to the fact that it helps to make the waterproof membrane to small molecules soluble in water but also maintains the flexible membrane in a wide temperature range . (Arteriosclerosis and cholesterol, Dr. K. Lehnert, a specialist in gynecology, Westrnohe, Biologische Medizin, 2 / 91. P.1-4) and ("LE KNOWLEDGE OF THE POPULATION ON CHOLESTEROL DIABETIC SERVICE pertaining to diabetes "A. Margiotta, MR ANNA M, MC BONACINA; Unit of Diabetology and Metabolic Diseases, the Hospital of Tradate (VA), Azienda Ospedaliera "Ospedale Circolo di Busto Arsizio, p. 97-100) ...
... The structure of cholesterol makes it hydrophobic and therefore poorly soluble and is absorbed through the intestinal bile salts. Cholesterol synthesis takes place mainly in the liver (endogenous cholesterol), even if at a number of other organs (adrenal gland, testis, aorta, etc...) Cholesterol is instead excreted in the bile, and then converted into bile acids in bile salts (cholesterol from gallstones can be obtained in pure crystalline) ...
... Cholesterol is important for our body because:
spoke in the formation and repair of cell membranes
is the precursor of vitamin D, steroid hormones and sex hormones (such as androgens, testosterone, estrogen and progesterone)
It is contained in hemoglobin
is the precursor of bile salts.
Since very little water-soluble cholesterol to be conveyed in the blood needs of carriers, which differ depending on the density. The density is inversely proportional to size: chylomicrons are particles larger and less dense, while high density lipoprotein (HDL) are the smallest and most dense (Barter P et al, N Engl J Med 2007; 357: 1301-1310):
" Pharmacology "Professor Raimondi
report Simona Sampirisi
Cholesterol is a lipid molecule sterol, but not a fatty alcohol is due to the presence of the hydroxyl group in position 5 '. E 'typical animal organisms, especially of vertebrates and is present in all tissues and in greater quantities in the brain, bile and blood. Cholesterol is a major component (~ 20%) of the "Cell membrane: its importance is due to the fact that it helps to make the waterproof membrane to small molecules soluble in water but also maintains the flexible membrane in a wide temperature range . (Arteriosclerosis and cholesterol, Dr. K. Lehnert, a specialist in gynecology, Westrnohe, Biologische Medizin, 2 / 91. P.1-4) and ("LE KNOWLEDGE OF THE POPULATION ON CHOLESTEROL DIABETIC SERVICE pertaining to diabetes "A. Margiotta, MR ANNA M, MC BONACINA; Unit of Diabetology and Metabolic Diseases, the Hospital of Tradate (VA), Azienda Ospedaliera "Ospedale Circolo di Busto Arsizio, p. 97-100) ...
... The structure of cholesterol makes it hydrophobic and therefore poorly soluble and is absorbed through the intestinal bile salts. Cholesterol synthesis takes place mainly in the liver (endogenous cholesterol), even if at a number of other organs (adrenal gland, testis, aorta, etc...) Cholesterol is instead excreted in the bile, and then converted into bile acids in bile salts (cholesterol from gallstones can be obtained in pure crystalline) ...
... Cholesterol is important for our body because:
spoke in the formation and repair of cell membranes
is the precursor of vitamin D, steroid hormones and sex hormones (such as androgens, testosterone, estrogen and progesterone)
It is contained in hemoglobin
is the precursor of bile salts.
Since very little water-soluble cholesterol to be conveyed in the blood needs of carriers, which differ depending on the density. The density is inversely proportional to size: chylomicrons are particles larger and less dense, while high density lipoprotein (HDL) are the smallest and most dense (Barter P et al, N Engl J Med 2007; 357: 1301-1310):
. .....
lipoprotein (VLDL) contain too many triglycerides, but the type synthesized in the liver (endogenous), and not from the meal as chylomicrons. The cholesterol content in VLDL is endogenous type, and is the 5-10 per cent of VLDL particles, which transport it to peripheral tissues. ("Effect of diet on the structural and functional heterogeneity of plasma lipoproteins, Bicchiega V, Ferretti G, Bacchetti T, Curatola G, Institute of Biochemistry, School of Specialization in Food Science, Faculty of Medicine, University of Ancona. Page 1-2).
intermediate-density lipoprotein (IDL) have fewer triglycerides compared to chylomicrons or VLDL, and a relatively high cholesterol content. The IDL is formed when VLDL lose their triglycerides in the blood during the passage. Such as VLDL, IDL represents an element of the transition in the transport of cholesterol to peripheral tissues and its return to the liver. ("Effect of diet on the structural and functional heterogeneity of plasma lipoproteins, Bicchiega V, Ferretti G, Bacchetti T, Curatola G, Institute of Biochemistry, School of Specialization in Food Science, Faculty of Medicine, University of Ancona. Page 1-2).
Low density lipoprotein (LDL): contengono ancora meno trigliceridi rispetto alle VLDL o alle IDL, ma la più elevata concentrazione di colesterolo tra tutte le lipoproteine. Le LDL trasportano direttamente il colesterolo ai tessuti periferici e al fegato. Per questa ragione costituiscono quello che comunenemente viene chiamato “colesterolo cattivo”, ovvero la forma più dannosa in cui il colesterolo si trova nel corpo umano. (“Effetto della dieta sulla eterogeneità strutturale e funzionale delle lipoproteine plasmatiche”, Bicchiega V,Ferretti G, Bacchetti T, Curatola G; Istituto di Biochimica, Scuola di Specializzazione in Scienza dell’Alimentazione, Facoltà di Medicina e Chirurgia, Università di Ancona. Pag 1-2).
HDL high-density lipoproteins: mainly consist of phospholipids and proteins, with small amounts of triglycerides (5%) and small amounts of cholesterol (25%). The HDL account for approximately 25 percent of blood cholesterol. Their function is to collect and recycle free cholesterol. They are also a source of cholesterol to the endocrine tissue, using it to synthesize hormones. For this reason, HDL is commonly called "good cholesterol", as they eliminate excess cholesterol from the circulation and the address to the tissues that are able to metabolize (also called lipoproteins are in fact garbage). ("Effect of diet on the structural and functional heterogeneity of plasma lipoproteins, Bicchiega V, Ferretti G, Bacchetti T, Curatola G, Institute of Biochemistry, School of Specialization in Food Science, Faculty of Medicine, University of Ancona . Page 1-2).
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Statins are more effective than other lipid-lowering drugs in reducing LDL cholesterol levels but less effective than fibrates in reducing triglycerides. However, statins reduce cardiovascular events and mortality associated with it regardless of the initial levels of cholesterol. These drugs should essere considerate per tutti i pazienti, compresi gli anziani, con malattia cardiovascolare sintomatica come per esempio quelli affetti da coronaropatia, malattia occlusiva arteriosa (vasculopatia periferica, ictus non emorragico o attacco ischemico transitorio) o diabete mellito (BNF 53 Copyright © BMJ Publishing Group Ltd and the RPS Publishing 2007. Guida all'uso dei farmaci 4, Copyright © Elsevier Masson srl 2007). La morbilità e mortalità cardiovascolare ha una prevalenza crescente con l’aumentare dell’età, raggiungendo i valori più elevati nelle fasce di età più avanzata, infatti nel soggetto anziano il rischio cardiovascolare viene spesso trascurato perché in età Advanced polypathology is often a situation of multi-drug therapy that may be difficult or inappropriate to add other therapeutic drugs to increase the stock of the elderly. The study conducted by Heart Protection Study (HPS) has demonstrated for the first time the effectiveness of statins in the prevention of major vascular events in elderly subjects. This study of secondary prevention was conducted for 5 years in 20,000 high-risk vascular patients with hypercholesterolemia aged 40-80 years, suffering from coronary heart disease (CHD), peripheral arterial disease and / or diabetes mellitus. The high abundance of elderly subjects allowed for the first time to assess the real impact of a statin, simvastatin, vascular morbid events more typical of the age's most advanced, particularly stroke (stroke).
In patients with diabetes mellitus the risk of developing cardiovascular disease depends on the time elapsed from the onset of diabetes, the complications, age, and concomitant risk factors (BNF 53 Copyright © BMJ Publishing Group Ltd and the RPS Publishing 2007. Guide to the use of drugs 4, Copyright © 2007 Elsevier Masson Srl). Statin therapy should be considered in all patients with both diabetes mellitus (type 1 and 2) older than 40 years and is in younger patients and that treatment should be considered if they are present: a organ damage, poor glycemic control (HbA1c greater than 9%), low levels of HDL cholesterol, elevated triglycerides, hypertension or family history of early cardiovascular events.
Statins can be used for the prevention of:
Statins can be used for the prevention of:
- cardiovascular events in asymptomatic patients with increased risk. Individuals with risk of cardiovascular events in 10 years of 20% or more benefit from statin therapy regardless of plasma levels of cholesterol and the use of statins should be associated with changes in lifestyle and other measures that reduce the risk of cardiovascular events. Treatment with statins should be considered even if the relationship between the concentration of total cholesterol and HDL is greater than 6. (BNF 53 Copyright © BMJ Publishing Group Ltd and the RPS Publishing 2007. Guide to the use of drugs 4, Copyright © 2007 Elsevier Masson Srl).
- "Ischemic stroke: statins have a protective effect against ischemic stroke in general on cerebrovascular disease, with obvious consequences related to the system of dispensation of these drugs is currently governed by Note 13 of the CUF ("THE POINT OF VIEW ON statins", * Giancarlo Berni, Stefano Santoni **, Antonio Salvetti °, Mario Montagnani ° °, ^ Andrea Messori, Gian Franco Gensini ^ ^. * Director of the Unit of Internal Medicine Company "Careggi" Firenze, ** General Practitioner in Florence, ° Director, Department of Internal Medicine, University of Pisa, ° · Prof. Associate Professor of Clinical Pathophysiology, University of Siena, ^ Hospital Pharmacist Company "Careggi", Florence; ^ ^ Director of the Institute of Clinical Medicine, University of Florence. TUSCANY MEDICAL October 2003).
- Action vasoprotective antiaterosclerotica and "especially in situations characterized by the presence of high values \u200b\u200bof trigliceridi.
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Le indicazioni della C.U.F. spiegano che le statine sono farmaci impiegati per la prevenzione secondaria cioè volte a ridurre la frequenza di casi esistenti della malattia in pazienti che hanno già manifestato la patologia. Le conoscenze sulle statine e sui loro meccanismi di azione sono indubbiamente progredite negli ultimi anni, tuttavia, le informazioni disponibili oggi non sono poi tanto diverse rispetto a quelle già note. Oggi, alla luce della nuove acquisizioni, si potrebbe ipotizzare un ampliamento dei limiti prescrittivi in termini di prevenzione sia primaria che secondaria ma si ritiene che la prevenzione primaria con le statine risulti ancora un’area caratterizzata da certezze minori.
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InterazioniLa capacity of a single cytochrome P450 to metabolize multiple drugs is the factor responsible for the large number of metabolic interactions that occur in clinical practice. The inhibition of metabolizing enzymes cause an increase in plasma levels of the drug in question and then an increase and a prolongation of their action. Statins, whose metabolism is inhibited, have a narrow therapeutic margin, which leads to clinically significant consequences. In addition to its therapeutic margin and the dose of the inhibitor, the extent of toxic effects depends on the importance of the pathway being inhibited and inhibited the enzyme, which in this case, è il solo o principale responsabile della biotrasformazione del farmaco, si hanno conseguenze gravi. All'interno della stessa classe vi sono grosse differenze riguardo all'affinità delle diverse statine ai vari citocromi P450, ciò che rappresenta il maggior potenziale d'interazione. Ad eccezione della pravastatina, che presenta caratteristiche idrofile e viene eliminata per la maggior parte in forma invariata attraverso i reni, le altre statine sono lipofile e vengono metabolizzate nel fegato dai citocromi P450 3A4 e 2C9.
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Succo di pompelmo: il consumo di succo di pompelmo dovrebbe essere evitato o limitato quando si assumono simvastatina, lovastatina o atorvastatina, soprattutto ad alte dosi, poiché può inhibit their metabolism in the intestine, mediated by CYP3A4 and thus result in increased plasma concentration of statins ("Safety profile of statins," Luisa Zanolla, Clinical Cardiology, Hospital of Verona. YEAR XIV - No. 48 - Published quarterly in February 2007).
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Editorial by O'Connor (Arch of Intern Med, 2006) clearly indicates that the lack of adherence to treatment by patients is the source of unnecessary health care costs, unnecessary adverse events and unnecessary deaths, so is necessary to educate patients to keep the treatment of life-saving drugs which are statin and seek a positive suggesting their complicity such as medicine and suspend to suspend them. The study of Wei (Heart, 2002), on adherence to statin treatment and rehospitalization in patients 6 years post-myocardial infarction, it is clear that the consistency chiaramennte treatment is associated with a lower risk of reinfarction. Report from the National Cholesterol Education Program (NCEP, year?), For the lipid-lowering treatment, show that despite the evidence of the benefits obtained by the reduction of LDL cholesterol, we are still far from optimal treatment, both in patients receiving both in terms of adherence to long-term care.
From Report found that:
- less than 50% of people in need of lipid-lowering treatment (pharmacological and / or diet) for cardiovascular (CV) risk, following treatment;
- less than 50% of people at high risk for CV is in drug treatment;
- only 1 / 3 treaties reaches the ideal LDL and less than 1 / 5 keep it;
- about 50% of people in treatment is still under treatment after 6 months and 12 months after the share drops to 20-30%, which is still more puzzling when you consider that it takes 6-12 months Almemo benefits because the treatment ports ("I keep 'THE CURE" Reading and discussion of the literature on statins Claudio Bettel; ULSS 20 Group C - District 4
From Report found that:
- less than 50% of people in need of lipid-lowering treatment (pharmacological and / or diet) for cardiovascular (CV) risk, following treatment;
- less than 50% of people at high risk for CV is in drug treatment;
- only 1 / 3 treaties reaches the ideal LDL and less than 1 / 5 keep it;
- about 50% of people in treatment is still under treatment after 6 months and 12 months after the share drops to 20-30%, which is still more puzzling when you consider that it takes 6-12 months Almemo benefits because the treatment ports ("I keep 'THE CURE" Reading and discussion of the literature on statins Claudio Bettel; ULSS 20 Group C - District 4
