Statins
3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors, known as
statins, constitute the most commonly, useful and effective
lipid-lowering group for primary and secondary cardiovascular
prevention. HMG-CoA reductase is a key enzyme in cholesterol
biosynthesis and its inhibition increases the expression of LDL receptor
(LDLr) on the surface of hepatocytes, with greater hepatic uptake of
LDL-C, leading to a reduction of the concentration of this lipoprotein
in plasma.
There is compelling evidence to support the use of statins in
cardiovascular prevention. Statin use reduces LDL-C by 20-50% depending
on potency and dose (31) and have shown an overall benefit with a 22%
risk reduction in major cardiovascular events (11).
In primary and secondary prevention, the benefit of the use of statins
is proportional to the baseline risk (32). The benefit of ASCVD risk
reduction includes patients in low and moderate cardiovascular risk
categories (11, 33-34). Furthermore, patients with diabetes mellitus
(DM), given their higher risk of ASCVD, have improved benefits in terms
of the reduction of major events (35).
In patients 75 years or older, statin therapy is recommended with half
of the standard dose and has shown benefit, particularly in patients
with previous ASCVD or with established disease (36). Discontinuation of
treatment in this patient population has demonstrated an increased
mortality risk, hence, interruption is not an option (37).
Statins are safe. Adverse events associated with statins are not related
with major disease or complications. The most common adverse event of
these drugs is statin-associated muscle symptoms and recommendations to
manage this clinical condition have been published (38). An increased
risk of incident diabetes with statin use (39) has been seen with a low
risk in absolute terms and when compared with benefits. The risk is
higher with intensive statin treatment (40).