Table 8.

Hypolipidaemic diet, lifestyle and drugs

Dietary and life style guidance	HMG-CoA reductase inhibitors (statins)	Fibrates
- decrease the intake of saturated animal fat (e.g. meats, cheese, sauces and fried foods).	- lower blood LDL-cholesterol levels by competitive inhibition of HMG coenzyme A decreasing liver synthesis of cholesterol	- reduce triglyceride levels by 20-50%.
- favour omega-3 fatty acids (flaxseed, canola and walnut oil, wheat germ, soya, mackerel, herring, salmon…).	- improve survival rates in adults with variable cholesterol levels (regardless of whether or not they have a history of coronary heart disease)	- side effects:
- maintain a normal body weight and do adapted regular physical exercise	- probably also beneficial in bone marrow recipients	o gallstones, transit and muscle disorders.
	- efficacy of rosuvastatin > atorvastatin (with the longest half-life) > simvastatin > pravastatin and fluvastatin (which are less expensive).	o Risk increased in combination with a statin or with altered kidney function and with ciclosporine.
	- statins other than fluva-, prava- and rosuvastatin, are metabolized by cytochrome P450 (or CYP3A4)	- Fenofibrate preferred to gemfibrozil because of fewer side effects, although it can sometimes increase creatinine levels.
	- can thus interfere with many drugs*, calcineurin and mTOR inhibitors, methotrexate, cimetidine, grapefruit juice.
	- CYP3A4 inhibitors should be avoided in combination with calcineurin inhibitors and statins
	- Statins have liver, muscle toxicity: high-dose (>80 mg) statins must not be prescribed.

*Main CYP3A4 inhibitors: calcium-blockers (diltiazem, verapamil), macrolides (erythromycin, clarithromycin), azole antifungals (itraco- and keto-conazole), antivirals (rito-, indi-, nelfi- and ampe-navir).