Statine per la prevenzione della pancreatite acuta

Statins for the Prevention of Acute Pancreatitis.de-Madaria E. Am J Gastroenterol. 2017 Oct 31. [Epub ahead of print]

In the early 1970s, Professor Akira Endo isolated the first statin, later called mevastatin, a potent inhibitor of 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMG-CoA reductase), from the fungus Penicillium citrinum. HMG-CoA reductase is the rate-controlling enzyme in the cholesterol synthetic pathway, and its inhibition by statins results in decreased serum levels of total and low-density lipoprotein cholesterol.

Statins substantially reduce cardiovascular morbidity and mortality in both primary and secondary prevention, and are used by millions of patients worldwide.Experimental and clinical evidence suggests that the beneficial effects of statins may extend beyond lowering cholesterol serum levels to include the so-called pleiotropic effects. The clinical relevance of these pleiotropic effects is controversial, but statins clearly have anti-inflammatory properties . Traditionally, statins were linked to drug-induced acute pancreatitis (AP) based on case reports , but a case–control study in 2006  and meta-analysis of large randomized trials in 2012 suggested that statin treatment is associated with a lower risk of developing AP. According to a prospective cohort study , patients undergoing chronic statin treatment may have milder episodes of AP and even decreased mortality according to individual and propensity score matching analysis. In 2015, Wu et al.  published a retrospective cohort study based on data from an integrated health-care system involving almost four million citizens. Simvastatin consumption was independently associated with a lower probability of having an episode of AP (adjusted risk ratio 0.626, 95% confidence interval 0.588–0.668). Similar results were noted for atorvastatin, suggesting a class effect. Full-text articles addressing the association between statins and AP are summarized in Table 1. Generally, cohort studies and meta-analyses of randomized controlled clinical trials suggest that statins protect against AP, whereas case reports and case–control studies (which are more prone to biases) show an increased risk of AP. leggi l'articolo

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