ACC/AHA/NHLBI Clinical Advisory on the Use and Safety of Statins

Pasternak, Richard C.; Smith, Sidney C.; Merz, C. Noel Bairey; Grundy, Scott M.; Cleeman, James I.; Lenfant, Claude

doi:10.1161/01.cir.0000032466.44170.44

Cited by 650 publications

(269 citation statements)

References 35 publications

Supporting

Mentioning

233

Contrasting

Unclassified

Order By: Relevance

“…Although statins have been known to be safe, the withdrawal of cerivastatin from the market because of fatal cases of rhabdomyolysis in connection with this compound has raised major concerns that certain pleiotropic effects of statins could also be harmful (4). The adverse effects of statins are elevations of hepatic enzymes, rhabdomyolysis, possible cancer, cataracts, peripheral neuropathies, and psychiatric disturbances (5).…”

Section: Introductionmentioning

confidence: 99%

Reduction of Serum Ubiquinol-10 and Ubiquinone-10 Levels by Atorvastatin in Hypercholesterolemic Patients

Mabuchi

Higashikata

Kawashiri

et al. 2005

JAT

107

View full text Add to dashboard Cite

Reduction of serum cholesterol levels with statin therapy decreases the risk of coronary heart disease. Inhibition of HMG-CoA reductase by statin results in decreased synthesis of cholesterol and other products downstream of mevalonate, which may produce adverse effects in statin therapy. We studied the reductions of serum ubiquinol-10 and ubiquinone-10 levels in hypercholesterolemic patients treated with atorvastatin. Fourteen patients were treated with 10 mg/day of atorvastatin, and serum lipid, ubiquinol-10 and ubiquinone-10 levels were measured before and after 8 weeks of treatment. Serum total cholesterol and LDL-cholesterol levels decreased significantly. All patients showed definite reductions of serum ubiquinol-10 and ubiquinone-10 levels, and mean levels of serum ubiquinol-10 and ubiquinone-10 levels decreased significantly from 0.81 ± ± ± ± ± 0.21 to 0.46 ± ± ± ± ± 0.10 µ µ µ µ µg/ml (p < 0.0001), and from 0.10 ± ± ± ± ± 0.06 to 0.06 ± ± ± ± ± 0.02 µ µ µ µ µg/ml (p = 0.0008), respectively. Percent reductions of ubiquinol-10 and those of total cholesterol showed a positive correlation (r = 0.627, p = 0.0165). As atorvastatin reduces serum ubiquinol-10 as well as serum cholesterol levels in all patients, it is imperative that physicians are forewarned about the risks associated with ubiquinol-10 depletion. J Atheroscler Thromb, 2005; 12: 111-119.

show abstract

Section: Introductionmentioning

confidence: 99%

Reduction of Serum Ubiquinol-10 and Ubiquinone-10 Levels by Atorvastatin in Hypercholesterolemic Patients

Mabuchi

Higashikata

Kawashiri

et al. 2005

JAT

107

View full text Add to dashboard Cite

show abstract

“…First, the negligible outcome benefits, combined with the potential side‐effects and higher costs may make the adoption of aggressive LDL cholesterol targets using statins among an elderly post‐ACS population unattractive from a clinical and cost‐effectiveness standpoint 38. Moreover, our results may question the merits of serial LDL cholesterol monitoring among statin‐adherent elderly populations.…”

Section: Discussionmentioning

confidence: 92%

Projected Real‐World Effectiveness of Using Aggressive Low‐Density Lipoprotein Cholesterol Targets Among Elderly Statin Users Following Acute Coronary Syndromes in Canada

Alter

Koh

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundThe extent to which outcome benefits may be achieved through the implementation of aggressive low‐density lipoprotein (LDL) cholesterol targets in real world settings remains unknown, especially among elderly statin users following acute coronary syndromes.Methods and ResultsA population‐based cohort study consisting of 19 544 post‐acute coronary syndrome statin‐users aged ≥66 years between January 1, 2017 and March 31, 2014 was used to project the number of adverse outcome events (acute myocardial infarction or death from any cause) that could be prevented if all post‐acute coronary syndrome elderly statin users were treated to 1 of 2 LDL cholesterol target levels (≤50 and ≤70 mg/dL). The number of preventable adverse outcomes was estimated by using model‐based expected event probabilities as derived from Cox Proportional hazards models. In total, 61.6% and 25.5% of the elderly patients met LDL cholesterol targets of ≤70 and ≤50 mg/dL, respectively, based on current management. No more than 2.3 adverse events per 1000 elderly statin users (95% confidence interval: −0.7 to 5.4, P=0.62) could be prevented over 8.1 years if all patients were to be treated from current LDL cholesterol levels to either of the 2 LDL cholesterol targets of 70 or 50 mg/dL.ConclusionsThe number of acute myocardial infarctions or death that could be prevented through the implementation of LDL cholesterol targets with statins is negligible among an elderly post‐acute coronary syndrome population. Such findings may have implications for the applicability of newer agents, such as proprotein convertase subtilisin/kexin type‐9‐ inhibitors.

show abstract

“…These adverse effects are of particular concern in patients that develop sepsis because liver failure is a common complication of sepsis and drugs used in treating sepsis, such as steroids and neuromuscular blocking agents, can also cause myopathies (Goa et al, 2008;Pasternak et al, 2002). Elevated liver transaminases occur in 0.5 to 2% of patients taking statins and are dosedependent; however, progression to liver failure due to statins is very rare.…”

Section: Adverse Effectsmentioning

confidence: 99%

“…Reversal of elevated transaminases frequently occurs with reduction in dose, and elevations do not often recur with either re-challenge or selection of another statin. Cholestasis and active liver disease are contraindications to statin use, but exacerbation of liver disease by statins has not been shown (Pasternak et al, 2002). Myopathies are characterized by non-specific muscle aches or joint pain, usually without elevations in creatinine kinase (CK).…”

Section: Adverse Effectsmentioning

confidence: 99%