From the Guidelines
Statins are a highly effective and widely recommended class of medications for reducing the risk of cardiovascular events, including heart attacks and strokes, in patients with or at high risk for atherosclerotic cardiovascular disease.
Pros of Statins
- Reduce the risk of major vascular events, including coronary heart disease death, recurrent MI, cerebrovascular events, coronary revascularization, and all-cause mortality 1
- Lower the risk of stroke by approximately 21% for each 1-mmol/L (39-mg/dL) decrease in LDL cholesterol 2
- Have anti-inflammatory and plaque stabilization effects, which can help to slow the progression or induce regression of atherosclerosis 3
- Are generally safe and well-tolerated, with rare but potentially serious side effects such as liver dysfunction and rhabdomyolysis 3 ### Cons of Statins
- May have potential interactions with other medications, such as ciclosporin, macrolides, and azole antifungals, which can increase the risk of side effects 3
- May not be beneficial for adults 76 years and older who are not already taking a statin, due to inadequate evidence 4
- May have varying effects on different patient populations, such as those with diabetes or kidney disease, which requires careful consideration and individualized treatment planning
- Require regular monitoring of liver function and lipid profiles to minimize the risk of side effects and ensure optimal efficacy 3 ### Key Considerations
- The decision to initiate statin therapy should be based on a patient's individual risk factors, including their calculated 10-year CVD event risk, and should take into account their age, sex, and other health conditions 4
- High-intensity statin therapy appears to confer incremental clinical benefit compared with less intensive therapy, particularly in patients with established atherosclerotic cardiovascular disease 1
- Statins should be prescribed in accordance with established guidelines, such as the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, which recommends treatment of patients ≤75 years of age who have clinical atherosclerotic cardiovascular disease with high-intensity statin therapy 1
From the Research
Benefits of HMG-CoA Reductase Inhibitors
- Reduce cardiovascular risk and decrease mortality by inhibiting the critical step of cholesterol synthesis 5
- Have a potent lipid-lowering effect, which reduces the risk of coronary heart disease and stroke 6
- May confer cardiovascular benefit by directly or indirectly modulating the inflammatory component of atherosclerosis 7
- Have been shown to slow progression of disease at a rate and to an extent that cannot be solely attributed to LDL reduction 8
Risks and Side Effects of HMG-CoA Reductase Inhibitors
- May have adverse effects, including musculoskeletal symptoms, increased risk of diabetes, and higher rates of hemorrhagic stroke 5
- Associated with an increased risk of diabetes mellitus and hepatic transaminase elevations 9
- Muscle side effects are the most commonly reported, although the effect on myalgia is still debated 9
- May cause cognitive dysfunction, cataracts, proteinuria, and haematuria, although a causal link has not been confirmed 9
Pharmacologic and Pleiotropic Actions
- Intermolecular differences among statins contribute to distinct pharmacologic and pleiotropic actions, including enhancement of endothelial-dependent nitric oxide bioavailability, anti-inflammatory activity, and inhibition of oxidative stress 8
- Certain statins may have a more pronounced effect on reducing cardiovascular risk due to their pleiotropic actions, which go beyond their lipid-lowering properties 6, 7