Drugs for the treatment of dyslipidemia

The article is professionally consulted by Master, Doctor Bui Tien Dat - Emergency Medicine - Cardiology - Emergency Resuscitation Department - Vinmec Hai Phong International General Hospital. The doctor has more than 12 years of experience in the field of emergency resuscitation - cardiology.

Dyslipidemia is a condition in which elevated total cholesterol, elevated triglycerides, increased low-density lipoprotein (LDL-C) and/or decreased high-molecular-weight lipoprotein (HDL-C) levels compared with normal values ​​in plasma.

The first treatment for dyslipidemia is lifestyle changes. If lifestyle changes after 2-3 months do not bring the desired effect, then it is necessary to prescribe treatment with the following classes of drugs to treat dyslipidemia:
Statins (HMG-CoA reductase inhibitors) Uses: Inhibits the enzyme Hydroxymethylglutaryl CoA Reductase - the enzyme that synthesizes total cholesterol, reduces endogenous total cholesterol, stimulates the synthesis of LDL-c receptors, increases the capture of LDL-c in the liver. The results reduce LDL-c, VLDL, total cholesterol, triglycerides and increase HDL-c. In addition, the statin group also reduces the inflammatory process of the vascular endothelium, helps in the degeneration of atheroma, and increases the synthesis of nitric oxide by endothelial cells.
Possible undesirable effects are increased liver enzymes, increased muscle enzymes when taking high doses or in the elderly or taking many drugs at the same time such as macrolide antibiotics. Use with caution in patients with liver diseases.
Indications for treatment: increase LDL-c, increase total cholesterol.

Fibrate group Effects: Reduces triglycerides by stimulating PPAR alpha, increases fatty acid oxidation, increases lipoprotein lipase enzyme synthesis, increases clearance of triglyceride-rich lipoproteins, inhibits hepatic apoC-III synthesis, increases clearance VLDL. Fibrates also increase HDL by promoting apoA-I and apoA-II expression.
Undesirable effects: Digestive disorders such as flatulence, abdominal distension, nausea, mild decrease in liver function, increased liver enzymes, gallstones, increased muscle enzymes, rash. Side effects often occur when taking high doses or due to the elderly or pre-existing kidney or liver disease. Increases the effect of anticoagulants, especially vitamin K antagonists. Do not use fibrates for pregnant or lactating women, liver failure, kidney failure.
Indications for treatment: Increased triglycerides
Nicotinic acid group (Niacin, vitamin PP). The drug has a triglyceride-lowering effect by inhibiting the breakdown from fat and reducing the synthesis of triglycerides in the liver, inhibiting the synthesis and esterification of fatty acids in the liver, increasing apo B degradation, reducing VLDL, lowering LDL and increasing HDL. due to decreased clearance of apoA-I).
Undesirable effects: Red face, itching, digestive disorders such as flatulence, abdominal distension, nausea, mild decrease in liver function, increased liver enzymes, gallstones, increased muscle enzymes, rash, increased resistance insulin. Side effects often occur when taking high doses, or elderly people or have kidney and liver disease first.
Indications: Increase LDL-C, decrease HDL-C, increase triglycerides.
Resin group (Bile acid sequestrants) Resin mechanism is the exchange of Cl- ions with bile acids, thereby increasing the synthesis of bile acids from cholesterol, increasing bile secretion and lowering cholesterol in the liver, stimulating the synthesis of LDL-receptors. c, increased excretion of LDL-c.
Indicated in case of elevated LDL-c.
Undesirable effects of Resin group: Symptoms of digestive disorders such as flatulence, abdominal distension, nausea, constipation.
Ezetimibe The drug inhibits the absorption of total cholesterol in the intestine, reduces LDL-c and increases HDL-c. The drug has very few side effects, which may be an increase in liver enzymes.
Dosage: 10mg/day.
Indications: increase LDL-c.

Omega 3 (Fish Oils) Mechanism of increased catabolism of triglycerides in the liver.
Commonly applied clinical dose: 3g/day, maximum dose of 6g/day.
Undesirable effects: Digestive disorders such as flatulence, abdominal distension, diarrhea.
Indicated in case of increased triglycerides.

Most drugs to treat dyslipidemia are metabolized by the liver, so during the use of lipid-lowering drugs, it is necessary to use additional drugs to help support and protect liver cells.
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