Statin therapy is currently included in the management strategy for primary prevention of Cardiovascular disease for adults with a risk greater than or equal to 20% for developing CVD over the next ten year period. This risk can be calculated on the bases of a variety of different risk factors including blood cholesterol levels and blood pressure.
Statins targes the liver cells, where cholesterol is made. They work by inhibiting 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMG CoA), which is an enzyme involved in cholesterol synthesis. The inhibition of HMG CoA reductase decreases the levels of Low Density Lipoprotein Cholesterol by slowing down the production of cholesterol in the liver, whilst also increasing the liver's ability to remove the LDL-C already in the blood. Five statins are currently in use in the UK: atorvastatin, fluvastatin, pravastatin, rosuvastatin and simvastatin. The differences are minor and atorvastatin is the most commonly prescribed. Although among the safest and most studied drugs available in the market today, statins do have potential side effects, which can be seen through regular blood tests, testing how welll the liver is working. If side effects are experienced, the different types of statins can be used or the dosage can be changed.Statins, by decreasing LDL cholesterol, reduce cardiovascular morbidity and mortality as well as the need for coronary artery interventions. Statins at doses that effectively reduce LDL cholesterol by 50% also seem to halt progression or even contribute to regression of coronary atherosclerosis. In general, the safety profile of statins is acceptable, and earlier observations that lipid-lowering treatment may contribute an increase in non-cardiovascular mortality (e.g. cancers, suicides, depression) or mental disorders have not been confirmed.
