Cholesterol: Friend or Foe?

Cholesterol, a molecule that is bothendogenous andexogenous,isessential to the body. It plays a role in thestructure of cell membranes, as well as in thesynthesis of hormones,vitamin D, andbile acids.

In plasma, it circulates with the help oflipoproteins:

• LDL transportscholesterol from the liver to peripheral tissues. When present in excess, it accumulates in the arterial intima, oxidizes, and triggers atherosclerosis.
• HDL, on the other hand, transports cholesterol back to the liver for breakdown.

 

When Cholesterol Runs Amok

Hypercholesterolemia is divided into two main categories:

• Primary: caused by genetic abnormalities or mutations inApoBorPCSK9.
• Secondary: caused bylifestyle, medicalconditions, orcertaintreatments.

 

Cholesterol-lowering drugs

Statins remainthe standard of care. They inhibitHMG-CoA reductase. Their efficacy ranges from 20% to 50%, depending on the specific drug and dose.Simvastatin andpravastatin should be taken in the evening, while the timing is more flexible for atorvastatin androsuvastatin. Monitoring focuses ontransaminases and, in cases of myalgia, oncreatine kinase. Be cautious ofinteractions (CYP3A4 inhibitors, grapefruit juice).

Ezetimibe worksas an adjunct by blocking intestinal absorption (NPC1L1 protein). On its own, it reduces LDL-C by 15 to 20%, but its main benefit lies incombination with a statin.

Ion-exchange resins(cholestyramine) bind to bile acids in the intestine, forcing their replacement. Their effectiveness is limited, and their gastrointestinal side effects (constipation, bloating) restrict their use.

PCSK9 inhibitors(evolocumab, alirocumab) provide an additional reduction in LDL-C of more than 50%. Administered by subcutaneous injection, they are indicated whentarget levels are not achieved with statins ± ezetimibe or in casesof intolerance.

 

Side effects of statins to watch out for

Muscle-related: muscle pain, cramps, weakness.

Liver function: elevated transaminases; initial laboratory testing and follow-up based on clinical findings.

Metabolic: slight increase in blood glucose levels.

Interactions: Use caution with potent CYP3A4 inhibitors, and avoid grapefruit juice when taking atorvastatin or simvastatin.

Drug interactions: gemfibrozil (contraindicated), fenofibrate (use with caution).

 

Key advice to offer

Eat a healthy diet: follow the Mediterranean model, and cut back on processed meats, highly processed foods, and saturated fats.

Get regular exercise: at least 30 minutes of appropriate physical activity per day.

Follow your treatment plan: take your medication every day at the same time, and never stop taking it without consulting your doctor.

Avoid these pitfalls: do not consume grapefruit with certain statins; limit alcohol intake (especially if your triglyceride levels are high); report any muscle pain or jaundice.

Incorporate natural aids: fiber or omega-3s can complement your treatment plan, but they should never replace your prescribed medication.

 

Which dietary supplements?

Dietary supplementsare still justaids. Here are a few options available:

• Ergysterol+® – Nutergia: made with white garlic, chrysanthellum, CoQ10, antioxidant vitamins, and trace minerals.
• Metarecod® – Aboca: a patented complex of plant fibers, gums, alginates, pectins, and polyphenols that supports lipid and carbohydrate metabolism.
• Liposterol® Fort – 3C Pharma: cilantro, bergamot, policosanol, and olive extract rich in hydroxytyrosol.
• Valbiotis® Pro Cholesterol: contains Lipidrive®, which studies show significantly reduces LDL-C.