Page 59 - Petelin, Ana. 2021. Ed. Zdravje starostnikov / Health of the Elderly. Proceedings. Koper: University of Primorska Press.
P. 59
mmatory disease. The power of nutrigenetics and nutrigenomics can be fur- nutrition of the elderly with atherosclerosis 57
ther enhanced with the coapplication of metabolomics, another rapidly emerg-
ing discipline. Management and prevention of CVD will benefit tremendously
from personalized medicine including individualized nutritional therapy. The
public health implications of nutritional therapy are enormous. Integration of
the progress in the omics, such as metabolomics, lipidomics, transcriptomics,
and proteomics, coupled with advances in nutrigenomic and nutrigenetic re-
search will make personalized medicine a reality. In the meantime, nutrition-
ists, medical practitioners and genetic counselors need to embrace the new nu-
trigenetics/nutrigenomics revolution to help bring the nutritional component
of preventive medicine from the dangerous stage of „generalization“ toward
the new era of „personalized medicine“ (Merched and Chan, 2013).
Atherosclerosis, which causes approximately half of all deaths of adults
over age 60 in industrialized nations, is a pandemic among inappropriately
nourished and/or physically hypoactive children, adolescents, and adults world
wide. Although nowadays statins are widely prescribed to middle age and el-
derly adults with high blood lipid levels as pharmacological prevention for
the late complications of atherosclerosis, from a critical point of view statins
seem not to solve the problem, especially when compared with certain natu-
ral ingredients of our nutrition like micronutrients as alternative strategy. Sta-
tin ingestion is associated with lowering of serum cholesterol and low-densi-
ty lipoprotein concentrations; some prospective studies have shown statistical
associations with subsequent modest reduction of mortality from cardiovas-
cular disease. However, specific biochemical pathways and pharmacological
roles of statins in prevention of atherosclerosis, if any, are unknown. Moreo-
ver, there have been no systematic cost-benefit analyses of life-style prophylax-
is versus statin prophylaxis versus combined life-style plus statin prophylaxis
versus neither life-style nor statin prophylaxis for clinically significant com-
plications of cardiovascular diseases in the elderly. Further, in the trials of ef-
fectiveness statins were not compared with management of nutrition, which is
the most appropriate alternative intervention. Such studies seem to be impor-
tant, as the ever increasing world population, especially in developing coun-
tries, now demand expensive statins, which may be unaffordable for mitigat-
ing the pandemic. Studies of this kind are necessary to identify more precisely
those patients for whom cardiovascular benefits will outweigh the risks and
costs of the statin treatment in comparison with nutritional interventions.
Against the background of the current pathogenetic concept of athero-
genesis some of its possible risk factors, particularly the roles of cholesterol and
homocysteine, and the effects of statins versus nutritional (micronutrients) in-
terventions in prevention and treatment of the disease are discussed. The pre-
vailing opinion that serum cholesterol as a mediator of the disease is increased
by eating saturated fats and decreased by eating polyunsaturated fats is being
challenged. Evidently, the beneficial effects of statins in atherosclerosis are not
mainly due to its cholesterol lowering effect, rather than to its “pleiotropic ef-
ther enhanced with the coapplication of metabolomics, another rapidly emerg-
ing discipline. Management and prevention of CVD will benefit tremendously
from personalized medicine including individualized nutritional therapy. The
public health implications of nutritional therapy are enormous. Integration of
the progress in the omics, such as metabolomics, lipidomics, transcriptomics,
and proteomics, coupled with advances in nutrigenomic and nutrigenetic re-
search will make personalized medicine a reality. In the meantime, nutrition-
ists, medical practitioners and genetic counselors need to embrace the new nu-
trigenetics/nutrigenomics revolution to help bring the nutritional component
of preventive medicine from the dangerous stage of „generalization“ toward
the new era of „personalized medicine“ (Merched and Chan, 2013).
Atherosclerosis, which causes approximately half of all deaths of adults
over age 60 in industrialized nations, is a pandemic among inappropriately
nourished and/or physically hypoactive children, adolescents, and adults world
wide. Although nowadays statins are widely prescribed to middle age and el-
derly adults with high blood lipid levels as pharmacological prevention for
the late complications of atherosclerosis, from a critical point of view statins
seem not to solve the problem, especially when compared with certain natu-
ral ingredients of our nutrition like micronutrients as alternative strategy. Sta-
tin ingestion is associated with lowering of serum cholesterol and low-densi-
ty lipoprotein concentrations; some prospective studies have shown statistical
associations with subsequent modest reduction of mortality from cardiovas-
cular disease. However, specific biochemical pathways and pharmacological
roles of statins in prevention of atherosclerosis, if any, are unknown. Moreo-
ver, there have been no systematic cost-benefit analyses of life-style prophylax-
is versus statin prophylaxis versus combined life-style plus statin prophylaxis
versus neither life-style nor statin prophylaxis for clinically significant com-
plications of cardiovascular diseases in the elderly. Further, in the trials of ef-
fectiveness statins were not compared with management of nutrition, which is
the most appropriate alternative intervention. Such studies seem to be impor-
tant, as the ever increasing world population, especially in developing coun-
tries, now demand expensive statins, which may be unaffordable for mitigat-
ing the pandemic. Studies of this kind are necessary to identify more precisely
those patients for whom cardiovascular benefits will outweigh the risks and
costs of the statin treatment in comparison with nutritional interventions.
Against the background of the current pathogenetic concept of athero-
genesis some of its possible risk factors, particularly the roles of cholesterol and
homocysteine, and the effects of statins versus nutritional (micronutrients) in-
terventions in prevention and treatment of the disease are discussed. The pre-
vailing opinion that serum cholesterol as a mediator of the disease is increased
by eating saturated fats and decreased by eating polyunsaturated fats is being
challenged. Evidently, the beneficial effects of statins in atherosclerosis are not
mainly due to its cholesterol lowering effect, rather than to its “pleiotropic ef-
