Comentario: problemas y mercadeo de las estatinas / Problems with statins and the marketing of these medications

ABSTRACT

All statins inhibit hydroxymethylglutaryl Coenzyme A Reductase but each has a different chemical structure that may have individual advantages. Some pharmaceutical companies have minimized side effects and stated that dose has no relation to incidence. To the contrary, dose is related to side effects with all statins. Myopathy occurs in up to 10.5 percent of patients taking a high dose. There is an attempt to sell statins that have lost patent protection over-the-counter. However, evidence supports medical supervision as offering greatest patient safety. Concerns were raised about ezetimibe after the initial ENHANCE (effcacy) and SEAS (cancer risk) study but these concerns appear to have been answered. Fenofbrate can be used with a statin but gemfbrozil is contraindicated. Coenzyme Q-10 possibly helps to mitigate the risk of myopathy with a statin but evidence is not universally accepted. JUPITER represented a valid outcomes study but made a claim that rosuvastatin has special value in risk management because of decreased high sensitivity C-Reactive Protein. This actually occurs with any statin, a decrease also enhanced by ezetimibe. Statins have benefted the lives of our patients but, as with any treatment, the physician needs to look critically at all the problems and claims made.