What is the use of statin (HMG-CoA reductase inhibitor)?

From the Guidelines

Statins are recommended for the primary prevention of cardiovascular disease in adults aged 40 to 75 years with no history of CVD, ≥ 1 CVD risk factors, and calculated 10-year CVD event risk of ≥ 10%. The use of statins in this population has been shown to have a moderate net benefit, with a reduction in the risk of cardiovascular events, including coronary heart disease death, recurrent MI, cerebrovascular events, coronary revascularization, and all-cause mortality 1.

Key Points

• Statins are a class of lipid-lowering medications that function by inhibiting the enzyme 3-hydroxy-3-methyl-glutaryl coenzyme A reductase, reducing levels of total cholesterol and LDL-C, and to a lesser extent, triglycerides.
• The USPSTF recommends using the ACC/AHA Pooled Cohort Equations to calculate 10-year risk of CVD events, taking into account age, sex, race, cholesterol levels, systolic blood pressure level, antihypertension treatment, presence of diabetes, and smoking status as risk factors 1.
• The likelihood that a patient will benefit from statin use depends on his or her absolute baseline risk of having a future CVD event, and clinicians should discuss with patients the potential risk of having a CVD event and the expected benefits and harms of statin use 1.
• High-intensity statin therapy appears to confer incremental clinical benefit compared with less intensive therapy, with a 15% further reduction in major vascular events 1.

Considerations for Implementation

• Clinicians should discuss with patients the potential risk of having a CVD event and the expected benefits and harms of statin use.
• Regular blood tests to monitor cholesterol levels and liver function are necessary, especially when starting therapy or changing doses.
• Patients should take statins consistently, usually in the evening for most types, and report muscle pain, weakness, or brown urine to their healthcare provider immediately.

Balance of Benefits and Harms

• The USPSTF concludes with moderate certainty that initiating use of low- to moderate-dose statins in this population has at least a moderate net benefit 1.
• The benefits of statin use include a reduction in the risk of cardiovascular events, while the harms include muscle pain, liver enzyme elevations, and rarely, rhabdomyolysis.

From the FDA Drug Label

Rosuvastatin tablets are an HMG Co-A reductase inhibitor (statin) indicated: To reduce the risk of major adverse cardiovascular (CV) events (CV death, nonfatal myocardial infarction, nonfatal stroke, or an arterial revascularization procedure) in adults without established coronary heart disease who are at increased risk of CV disease based on age, high-sensitivity C-reactive protein (hsCRP) ≥2 mg/L, and at least one additional CV risk factor. As an adjunct to diet to: reduce LDL-C in adults with primary hyperlipidemia. reduce LDL-C and slow the progression of atherosclerosis in adults reduce LDL-C in adults and pediatric patients aged 8 years and older with heterozygous familial hypercholesterolemia (HeFH) As an adjunct to other LDL-C-lowering therapies, or alone if such treatments are unavailable, to reduce LDL-C in adults and pediatric patients aged 7 years and older with homozygous familial hypercholesterolemia (HoFH) As an adjunct to diet for the treatment of adults with: Primary dysbetalipoproteinemia. Hypertriglyceridemia.

The use of statin (HMG-CoA reductase inhibitor) is to:

• Reduce the risk of major adverse cardiovascular events in adults without established coronary heart disease who are at increased risk of CV disease
• Lower LDL-C in adults with primary hyperlipidemia, heterozygous familial hypercholesterolemia (HeFH), and homozygous familial hypercholesterolemia (HoFH)
• Slow the progression of atherosclerosis in adults
• Treat primary dysbetalipoproteinemia and hypertriglyceridemia in adults 2 2 3

From the Research

Use of Statin (HMG-CoA Reductase Inhibitor)

The use of statin, also known as HMG-CoA reductase inhibitor, is a widely accepted treatment for hyperlipidemia and primary prevention of cardiovascular disease. The main purpose of statin therapy is to reduce the risk of cardiovascular events, such as heart attacks and strokes, by lowering cholesterol levels in the blood.

Benefits of Statin Therapy

• Reduces the risk of major adverse cardiovascular events, including coronary heart disease and ischemic stroke 4, 5
• Lowers the risk of non-fatal myocardial infarction and non-fatal stroke 6
• Reduces the risk of cardiovascular mortality in patients with familial hypercholesterolemia or severe primary hypercholesterolemia 5
• Has a moderate net benefit for adults aged 40 to 75 years with no history of CVD and who have 1 or more CVD risk factors and an estimated 10-year CVD event risk of 10% or greater 7

Harms and Limitations of Statin Therapy

• Associated with myalgias, myopathy, musculoskeletal injury, liver injury, and increased diabetes risk 4
• May have little or no effect on all-cause mortality in certain populations, such as elderly patients treated for primary prevention 8
• Has uncertain effects on health-related quality of life, as none of the included studies reported on this outcome 6
• May have limited benefits for adults 76 years or older with no history of CVD, as the evidence is insufficient to determine the balance of benefits and harms 7

Recommendations for Statin Use

• The US Preventive Services Task Force recommends that clinicians prescribe a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more CVD risk factors and an estimated 10-year CVD risk of 10% or greater 7
• The USPSTF recommends that clinicians selectively offer a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more of these CVD risk factors and an estimated 10-year CVD risk of 7.5% to less than 10% 7