Statins
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Introduction
Statins are lipid-lowering drugs used in patients with high cholesterol, both pre-and post-myocardial infarction.
Doubling a dose of statins decreases the LDL by 6%.
Statins reduce hepatic cholesterol synthesis, lower intrcellular cholesterol, stimulate LDL uptake. The net effect is to decrease LDL levels in the blood. Decreases oxidative stress; leads to plaque stability.
Indications
- hyperlipidemia
- In patients with coronary heart disease and metabolic syndrome, at 5 year follow-up major cardiac events were less common in patients receiving atorvastatin 80 mg (9.5%) than those receiving atorvastatin 10 mg (13%) (hazard ratio 0·71; 95% CI 0·61–0·84; p<0·0001) Lancet, 2006
- A primary event occurred in 8.7% of patients receiving 80 mg of atorvastatin, as compared with 10.9% receiving 10 mg of atorvastatin, representing an absolute reduction in the rate of major cardiovascular events of 2.2 percent and a 22 percent relative reduction in risk (hazard ratio, 0.78; 95 percent confidence interval, 0.69 to 0.89; P<0.001). There was no difference between the two treatment groups in overall mortality. NEJM, 2005
- also appear to have an effect on inflammation
Further reductions in LDL cholesterol safely produce definite further reductions in the incidence of heart attack, of revascularisation, and of ischaemic stroke, with each 1·0 mmol/L reduction reducing the annual rate of these major vascular events by just over a fifth. There was no evidence of any threshold within the cholesterol range studied, suggesting that reduction of LDL cholesterol by 2-3 mmol/L would reduce risk by about 40-50%. (CTT, 2010).
Common Medications
Guidance on Use
Adverse Effects
short term
- constipation
- dyspepsia
- farting
long term
- muscle breakdown; acute renal failure; serum creatine phosphokinase (CPK) measures rhabdomyolysis and should be done 6 weeks following the start
- liver failure
Resources and References
Cholesterol Treatment Trialists’ (CTT) Collaboration et al. 2010. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 376(9753):1670-81.
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