Choosing statins: a review to guide clinical practice

Abstract

Statins are among the most widely prescribed medicines in the world and have proved their value in reducing cardiovascular events and mortality. Many patients report adverse effects that lead to interruption of treatment. This review aims to individualize statin treatment, considering efficacy for reducing cardiovascular risk and safety, in the setting of specific diseases, to minimize the side effects and improve compliance. We gathered evidence that may help clinicians to choose specific statins in different clinical situations, such as the risk of new diabetes, chronic kidney disease, liver disease, human immunodeficiency virus infection, organ transplant, heart failure and elderly people. Efficacy of statins is well established in a large number of clinical conditions. Therefore, main objective is to revise statin in specific clinical settings, based on pharmacokinetics, safety, drug metabolism and interactions to provide the best choice in different clinical scenarios.

Imaging subclinical coronary atherosclerosis to guide lipid management, are we there yet?

“…In the JUPITER trial, the incidence of diabetes was 25% higher in the rosuvastatin group, and was associated with advanced age, increased fasting blood glucose, and metabolic syndrome. The risk of new-onset diabetes must be weighed against the risk of MACE and mortality [ 133 ]. In patients with CKD, a post hoc analysis demonstrated that the glomerular filtration rate remained stable with atorvastatin but significantly decreased in the rosuvastatin group ( p =0.036).…”

“…In patients with CKD, a post hoc analysis demonstrated that the glomerular filtration rate remained stable with atorvastatin but significantly decreased in the rosuvastatin group ( p =0.036). Atorvastatin but not rosuvastatin, has proven renoprotective effects in the CKD population [ 133 ].…”

The Link between Magnesium Supplements and Statin Medication in Dyslipidemic Patients

“…Patients with chronic kidney disease should use atorvastatin, fluvastatin, pravastatin, or simvastatin because they do not undergo renal elimination, so they do not need dose adjustment [ 86 ]. Meanwhile, statins may improve renal function by lowering albuminuria [ 87 , 88 , 89 ].…”

Analisis Interaksi Obat Penyakit Ginjal Kronik di RSUD Prof. Dr. W. Z. Johannes Kupang

“…Induktor dan inhibitor dari CYP-450 isoenzim merupakan penyebab dari interaksi obat golongan statin. Pada penggunaan dengan amlodipin, terjadi inhibisi metabolisme simvastatin pada CYP450 3A4 di liver yang menyebabkan peningkatan risiko rhabdomiolisis [18].…”

“…Pada bentuk rhabdomiolisis yang paling parah, laju mortalitas pasien dapat meningkat hingga 59% [20]. Oleh karena itu, Borges et al menyimpulkan pada penelitiannya untuk menggunakan atorvastatin pada pasien PGK yang juga menggunakan amlodipine dengan tingkat keparahan interaksi sedang dan dapat dilakukan pemantauan [18].…”