“Let food be your medicine and let medicine be your food.” Hippocrates
Cholesterol-lowering therapy and cell membranes. Stable plaque at the expense of unstable membranes?
Glyn Wainwright, Luca Mascitelli, Mark R. Goldstein
Independent Reader of Research, Leeds, United Kingdom
Medical Service, Comando Brigata Alpina “Julia”, Udine, Italy
Fountain Medical Court, Bonita Springs, FL, USA
Arch Med Sci 2009; 5, 3: 289-295
Current guidelines encourage ambitious long-term cholesterol lowering with statins, in order to decrease cardiovascular disease events. However, by regulating the biosynthesis of cholesterol we potentially change the form and function of every cell membrane from the head to the toe. As research into cell morphology and membrane function realises more dependencies upon cholesterol rich lipid membranes, our clinical understanding of long-term inhibition of cholesterol biosynthesis is also changing. This review of non-cardiovascular research concerning such membrane effects raises important new issues concerning the clinical advantages and disadvantages of the long-term use, and broadening criteria, of cholesterol reductions.
We are now realizing that the intricate connection between endocytosis and exocytosis, cholesterol-rich lipid membranes and the trafficking of lipoproteins within and between cells is the key to understanding the benefits and detriments of cholesterol lowering therapies. Current guidelines encourage aggressive and long-term cholesterol lowering with statins, in order to decrease cardiovascular disease events . The main benefits of this therapy are thought to be due to plaque stabilization in the arterial wall . However, cholesterol lowering alters cell membranes from head to toe, the implication of which may be good, bad or neither. Most importantly, more research is needed in this field, as wider segments of the population are exposed to aggressive cholesterol lowering. This research should answer the question: Is it possible, with aggressive cholesterol lowering, to achieve long-term plaque stability and simultaneously maintain cellular membrane integrity and function?
It has recently been shown that high LDL cholesterol is not a major cause of death at the population level. Changing our current practice pattern could take many years, but we may one day prescribe cholesterol-raising medications to certain patients.