Cardiovascular disease (CVD) may account for up to one third of deaths in England and Wales, with the majority related to ischaemic heart disease. Modifiable risk factors comprise smoking, hypertension and raised cholesterol levels. The statins are used for the primary and secondary prevention of cardiovascular disease.
What are the statins?
The statins include atorvastatin, fluvastatin, pravastatin, rosuvastatin and simvastatin. The statins competitively inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, an enzyme involved in cholesterol synthesis. They are more effective than other lipid-regulating drugs at lowering LDL-cholesterol, but they are less effective than the fibrates in reducing triglyceride concentration.
Importantly, statins reduce cardiovascular disease events and total mortality, irrespective of initial cholesterol concentration.
How to start a statin
Patients should be fully counselled about the risks and benefits of statin therapy, and also advised on lifestyle adjustments. It is of note that statins may cause raised blood glucose levels, especially in those with impaired glucose regulation. In these cases it is likely that the benefits outweigh the risks of statin therapy.