Introduction on Statins: Practical Considerations – A Review
Statins are currently the most efficacious and widely prescribed lipid-lowering medications.1 Numerous randomised controlled trials across a spectrum of baseline atherosclerotic cardiovascular disease (ASCVD) risk show that a 1.0 mmol/L (~40 mg/dL) reduction in low-density lipoprotein cholesterol (LDL-C) with statin therapy is associated with an overall 21 % reduction in major vascular events and 20 % reduction in coronary death.2 Prescribing behaviour of statins has dramatically changed in the last 20 years, with a sixfold increase of statin use in 18–64 year olds and an eightfold increase in adults >65 years old in the US.1 Globally, in the Organisation for Economic Co-operation and Development (OECD) countries, the use of cholesterol-lowering medications including statins has tripled since 2000.3 The recent release of the 2013 ACC/AHA cholesterol guidelines provided a dramatic shift in the treatment approach of cholesterol from the previous Adult Treatment Panel III (ATP III) guidelines, with a focus on fixed dose moderate/high intensity statin treatment.4 According to the new guidelines, the number of eligible individuals for statin treatment is estimated to increase. In comparison, the 2011 ESC/EAS guidelines for cholesterol management risk stratify patients into four risk groups: very high, high, moderate or low risk based on the Systematic Coronary Risk Evaluation (SCORE) risk chart and target specific LDL-C goals.5 The various guidelines and increasing use of statins presents a challenge for providers and a need for practical considerations for use.5,6 It still remains unclear how the ACC/AHA guidelines will affect practice in Europe.