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).