What is statin medication?

From the Guidelines

Statin medication should be prescribed to all patients with a history of myocardial infarction (MI) to reduce the risk of recurrent cardiovascular events, with high-intensity statin therapy recommended for patients ≤75 years of age and moderate-intensity statin therapy for those >75 years of age, as stated in the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults 1. The most frequently prescribed statins include atorvastatin (Lipitor), rosuvastatin (Crestor), simvastatin (Zocor), and pravastatin (Pravachol).

• Typical starting doses range from 10-20mg daily for atorvastatin, 5-10mg daily for rosuvastatin, 20-40mg daily for simvastatin, and 20-40mg daily for pravastatin, usually taken in the evening.
• Treatment is typically long-term, often lifelong, with regular monitoring of lipid levels and liver function tests. Statin therapy has been shown to reduce cardiovascular events, including coronary heart disease death, recurrent MI, cerebrovascular events, coronary revascularization, and all-cause mortality, as demonstrated in multiple secondary prevention trials 1.
• The Cholesterol Treatment Trialists conducted meta-analyses of individual participant data from randomized trials of more versus less intensive statin regimens, demonstrating a highly significant 15% further reduction in major vascular events with more intensive regimens 1. Potential side effects of statin therapy include muscle pain, liver enzyme elevations, and rarely, rhabdomyolysis, and patients should report muscle pain, weakness, or brown urine to their healthcare provider immediately 1.
• Statins should be taken consistently, and patients should maintain a heart-healthy diet and regular exercise to maximize benefits. It is also important to note that statin therapy should be individualized in persons >75 years of age according to the potential for ASCVD risk-reduction benefits, adverse effects, drug-drug interactions, and patient preferences, as recommended in the 2013 ACC/AHA Guideline 1.
• Grapefruit juice should be avoided with some statins as it can increase the risk of side effects. Regular monitoring of lipid levels and liver function tests is necessary to ensure the safe and effective use of statin therapy, and patients should be evaluated for new-onset diabetes according to the current diabetes screening guidelines 1.

From the FDA Drug Label

Atorvastatin calcium tablets are an HMG-CoA reductase inhibitor (statin) indicated The medication is a statin, specifically atorvastatin.

• The main use of this medication is to reduce the risk of myocardial infarction (MI), stroke, revascularization procedures, and angina in adults with multiple risk factors for coronary heart disease (CHD).
• It is also used to reduce low-density lipoprotein (LDL-C) in adults with primary hyperlipidemia and in adults and pediatric patients with heterozygous familial hypercholesterolemia (HeFH) 2.

From the Research

Statin Medication

• Statins are a type of medication that inhibits 3-hydroxyl-3-methylglutaryl coenzyme A reductase (HMG-CoA reductase) to reduce low-density lipoprotein (LDL) by about 20% to 45% 3
• However, up to 15% of patients cannot tolerate the potential side effects of high statin dosages, and several patients also still do not reach their optimal LDL goals after being treated with statins 3
• Statins are the most potent drugs for lowering LDL-C and are well tolerated in most patients 4

Combination Therapy

• Combining statins with other medications such as ezetimibe can produce additional LDL-C reduction, allowing many patients to reach LDL-C targets 4
• The addition of ezetimibe to simvastatin, atorvastatin, or rosuvastatin therapy can result in greater LDL-C reductions and goal attainment compared to titrating statin monotherapy 5
• A fixed-dose combination of rosuvastatin/ezetimibe is indicated as an adjunctive therapy to diet for the management of primary hypercholesterolemia in adults and has been shown to be effective in reducing LDL-C and total cholesterol 6

High-Risk Patients

• High-risk patients, such as those with atherosclerotic cardiovascular disease (ASCVD) or severe hypercholesterolemia, may benefit from high-intensity statin therapy or combination therapy with ezetimibe and/or other medications 7
• The goal for high-risk patients is to achieve a low-density lipoprotein cholesterol reduction of 50% or greater, and combination therapy may be necessary to achieve this goal 7

Efficacy and Safety

• Statins, ezetimibe, and combination therapy have been shown to be effective in reducing LDL-C and achieving recommended LDL-C levels 3, 4, 6, 5
• The safety profile of statins, ezetimibe, and combination therapy has been evaluated in several studies, and the results suggest that these medications are generally well-tolerated 3, 4, 6, 5