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Har kost och statiner var för sig eller i kombination någon effekt på LDL och HDL?
Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
2019 (Swedish)Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
Abstract [sv]

BakgrundKolesterol är en viktig byggsten i våra celler. Kolesterol stabiliserar cellmembranen och används bland annat till syntesen av östrogen, testosteron, kortisol och vitamin D samt för att bilda gallsyror. Kolesterol syntetiseras i levern men tas även upp via kosten. Kolesterol transporteras i blodet med hjälp av olika lipoproteiner som t. ex. low-density lipoprotein (LDL) och high-density lipoprotein (HDL).Höga värden av LDL och låga värden av HDL är kopplade till en ökad risk att drabbas av ateroskleros som i sin tur ökar risken att drabbas av hjärt-och kärlsjukdomar som t. ex. hjärtinfarkt. Syfte: Syftet med arbetet var att studera hur plasmakoncentrationen av LDL och HDL förändras vid olika dieter i kombination med statiner eller utan statiner samt se hur koncentrationerna förändras vid  läkemdelsbehandling med statiner som monoterapi eller i kombination med ezetimib. Metod: Detta arbete är en litteraturstudie baserad på sju olika randomiserade kontrollerade studier sökta från databasen PubMed. I tre av studierna utvärderas kostens roll att sänka kolesterolet. I två studier behandlades patienter med atorvastatin som monoterapi eller med kombination av ezetimib. Två studier utvärderade om simvastatin ska tas på morgon eller kväll samt om simvastatin skall tas i kombination med LCHF-kost jämfört med simvastatin plus ezetimib i kombination med LCHF-kost. Resultat: Resultaten visar att viktreducering och kostomläggning har stor betydelse vid förhöjdanivåer av LDL samt vid låga nivåer av HDL. Resultaten visar även att statiner i kombination med ezetimib har störst effekt att sänka nivåerna av LDL och öka HDL-nivåerna. Av resultaten framgår också att kontrollerad frisättning av simvastatin har likvärdig effekt oavsett om de adminstreras morgon eller kväll. Slutsats: Denna litteraturstudie har visat att viktreducering och kost är ett bra och säkert tillvägagångssätt att få positiva effekter på HDL- och LDL-koncentrationerna. Statiner är förstahandspreparat vid blodfettsrubbningar och vid förhöjda kolesterolvärden och har en god effekt på kolesterol-nivåerna. För bästa resultat bör kost med låg andel kolhydrater kombineras med statiner och ezetimib.

Abstract [en]

Background: Cholesterol is an important part in our cells. Cholesterol stabilize cell membranes and is needed for the synthesis of estrogen, testosterone, cortisol, vitamin D and in the formation of bile acid. Cholesterol is synthesized in the liver but the body also absorbs cholesterol from the diet. The transport of cholesterol in the blood is taken care of by LDL and HDL. When the levels of LDL are increased and HDL are decreased there is an increased risk of developing atherosclerosis and cardiovascular diseases which are the main cause of death in the western countries. 

Purpose: One of three different purposes of this presented study was to evaluate if the levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) were changed when following different diets. The second purpose was to study the change in levels of LDL and HDL change after treatment with statins as monotherapy or in combination with ezetimibe. The third part of this study was to see how LDL and HDL were changed when different diets were combined with statins. 

Method: This work was a literature study based on seven different randomized controlled trials that were found in the database PubMed. Three of the studies evaluated the role of the different diets when aiming at reducing the cholesterol levels. In two of the studies patients were either treated with atorvastatin as monotherapy or with atorvastatin plus ezetimib. The last two studies evaluated the use of simvastatin in combination with LCHF-diet as compared to the use of simvastatin plus ezetimib which were used in combination with a LCHF-diet.

Results: The results showed that weight reduction and the choice of a specific diet are important factors when aiming at a decrease in levels of LDL and an increase in levels of HDL. Moreover, results obtained also suggested that statins, when used in combination with ezetimibe, gave the largest effect and was found to decrease levels of LDL and increase levels of  HDL. According to the results, it may be concluded that the controlled release of simvastatin has an equivalent effect on these levels regardless if administered in the morning or in the evening.

Conclusion: The results obtained in this work suggest that weight reduction and eating according to a diet that consists of a low proportion of carbohydrates may be a good and safe approach to reduce the levels of  LDL and increase the levels of  HDL. Statins can be considered to be the first alternative to treat dyslipidemia and should be used at elevated levels of cholesterol. To achieve the best result, an analysis of the selected literature in this work, suggest that a low-carbohydrate diet should be combined with the use of statins and ezetimibe. 

Place, publisher, year, edition, pages
2019. , p. 26
Keywords [en]
LDL, HDL, statins
Keywords [sv]
LDL, HDL, statiner, kost
National Category
Basic Medicine
Identifiers
URN: urn:nbn:se:lnu:diva-82401OAI: oai:DiVA.org:lnu-82401DiVA, id: diva2:1313289
Educational program
Bachelor of Science Programme in Pharmacy, 180 credits
Supervisors
Examiners
Available from: 2019-05-03 Created: 2019-05-02 Last updated: 2019-05-03Bibliographically approved

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