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Statins: Actions, side effects, and administration
Statins: Actions, side effects, and administration
Author:
Robert S Rosenson, MD
Section Editor:
Mason W Freeman, MD
Deputy Editor:
Sara Swenson, MD
Literature review current through: Apr 2023.
This topic last updated: Oct 07, 2022.

INTRODUCTION

Lipid-altering agents encompass several classes of drugs that include hydroxymethylglutaryl (HMG) CoA reductase inhibitors or statins, fibric acid derivatives, bile acid sequestrants, cholesterol absorption inhibitors, and nicotinic acid. These drugs differ with respect to mechanism of action and to the degree and type of lipid lowering. Thus, the indications for a particular drug are influenced by the underlying lipid abnormality. Conventional dosing regimens and common adverse reactions are described in a table (table 1) and the range of expected changes in the lipid profile are listed in a separate table (table 2).

Lipid lowering, at least with statins, is beneficial for primary and secondary prevention of coronary heart disease in patients with dyslipidemias. (See "Low-density lipoprotein cholesterol-lowering therapy in the primary prevention of cardiovascular disease" and "Management of low density lipoprotein cholesterol (LDL-C) in the secondary prevention of cardiovascular disease".)

The mechanisms of benefit seen with lipid lowering are incompletely understood. Regression of atherosclerosis occurs in only a minority of patients; furthermore, clinical benefits of lipid lowering are seen in as little as six months, before significant regression could occur. Thus, other factors must contribute; these include plaque stabilization, reversal of endothelial dysfunction, and decreased thrombogenicity. (See "Mechanisms of benefit of lipid-lowering drugs in patients with coronary heart disease".)

The characteristics and efficacy of the statins will be reviewed here (table 3). The efficacy of fibrates, lipid-lowering drugs other than statins and fibrates, and diet and dietary supplements are also discussed separately. (See "Low-density lipoprotein cholesterol lowering with drugs other than statins and PCSK9 inhibitors" and "Lipid management with diet or dietary supplements" and "Low-density lipoprotein cholesterol lowering with drugs other than statins and PCSK9 inhibitors", section on 'Fibrates'.)

The major adverse reaction limiting statin use is the development of muscle symptoms, a condition known as statin-associated muscle symptoms (SAMS). This problem, including predisposing drug interactions, is discussed in detail separately. (See "Statin muscle-related adverse events".)

This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms ©2023 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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