Statins treatment monitoring

Some investigators have concluded that rare drug-induced reversible hepatotoxicity calls for close monitoring of liver enzymes in long-term treatment with statin-fibrate combinations (75). 

Despite inhibition of HMG-CoA reductase by statins, cells compensate by increasing enzyme expression several fold. However, the total body cholesterol is reduced by 20-40% due to increased expression of LDL-receptors after statin administration this enhances LDL (the major cholesterol carrying lipoprotein) clearance from serum with a net reduction of serum cholesterol (Chapter 20). Individuals who lack functional LDL-receptors (homozygous familial hypercholesterolemia. Chapter 20) do not benefit from statin therapy. However, statin therapy is useful in the treatment of heterozygous familial hypercholesterolemia. Since HMG-CoA reductase plays a pivotal role in the synthesis of many products vital for cellular metabolism, inhibitors of the enzyme may have toxic effects. Monitoring of liver and muscle function may be necessary to detect any toxicity of statin drug therapy. A decreased risk of bone fractures with statin therapy has been observed in subjects age 50 years or older, who are being treated for hypercholesterolemia. The mechanism of action of statins in bone metabolism may involve inhibition of prenylation... 

After being counseled about lifestyle and dietary changes, the patient was started on atorva-statin. During his treatment with atorvastatin, it is important to routinely monitor serum concentrations of (A) Blood urea nitrogen (BUN)... 

One study, published in a major nutrition journal in 2005, involved 34 people with high cholesterol. They were divided into three groups, then randomly placed into three different treatment scenarios. They followed each treatment for one month, during which all food and medication was provided and monitored. The control treatment involved placing the subjects on a very low saturated fat diet The second treatment combined a very low saturated fat diet with a 20 mg dose of a popular statin medication. The third treatment combined a very low saturated fat diet with a special diet containing specific "doses" of cholesterol-lowering foods that included the following ... 

---