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Statins: The Backbone of Treatment of Dyslipidemia

Received: 23 September 2020    Accepted: 8 February 2021    Published: 9 March 2021
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Abstract

Statins are a panacea for secondary prevention of atherosclerotic cardiovascular disease and primary prevention in high-risk individuals. They are very well tolerated and side effects like muscle toxicity and increased risk of new onset of diabetes are seen in a minority of cases. They are also recommended in diabetic patient because the benefit is many times more than the risk of diabetes. Statins reduce total cholesterol, LDL cholesterol, Apo B, non-HDL cholesterol, and triglycerides, and also increase high-density lipoprotein (HDL) cholesterol levels in most patients with hypercholesterolemia and combined hyperlipidemia. Statins are not indicated in individuals with Frederickson Class I and V hyperlipidemias. Extensive literature supports use of statins in coronary heart disease (CHD) patients for treatment of dyslipidemia and secondary prevention. It has also been recognized that in secondary prevention and ACS populations lower LDL may be better. Trials have compared moderate with more robust LDL-C reduction, using maximum doses of atorvastatin or simvastatin. Available statins differ in their ability to reduce atherogenic lipoproteins and raise the level of high-density lipoprotein (HDL) cholesterol. Depending on dose used and specific statin, LDL cholesterol reduction of 18% to 55% can be expected. Atorvastatin and rosuvastatin are the most potent statins for lowering LDL-C cholesterol levels, yielding average reductions that approach 50% for atorvastatin and exceed 50% for rosuvastatin at the highest dose. Reduction in triglycerides with statins ranges from 7% to 30%, and is higher in hypertriglyceridemic populations and at higher statin doses. HDL levels usually rise by 5% to 10%. No consistent dose response relationship between statin dose and degree of HDL increase is seen.

Published in American Journal of Internal Medicine (Volume 9, Issue 2)

This article belongs to the Special Issue Dyslipidemia: Flash Back and Vision Ahead

DOI 10.11648/j.ajim.20210902.13
Page(s) 76-82
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Dyslipidemia, Statin, Atherosclerosis

References
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[5] Stamler J, Wentworth D, Neaton JD. Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356 222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT) JAMA. 1986; 256: 2823–8.
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[7] Nordestgaard BG, Langsted A, Mora S, et al. Fasting is not routinely required for determination of a lipid profile: clinical and laboratory implications including flagging at desirable concentration cut-points—a joint consensus statement from the European Atherosclerosis Society and European Federation of Clinical Chemistry and Laboratory Medicine. Eur Heart J. 2016; 37: 1944–58.
[8] Grundy SM, Vega GL, Tomassini JE, et al. Comparisons of apolipoprotein B levels estimated by immunoassay, nuclear magnetic resonance, vertical auto profile, and non-high-density lipoprotein cholesterol in subjects with hypertriglyceridemia (SAFARI Trial). Am J Cardiol. 2011; 108: 40–6.
[9] Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC /AACVPR/ AAPA/ABC/ ACPM/ADA/ AGS/APhA/ ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 Nov 10 [E-pub ahead of print].
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Cite This Article
  • APA Style

    Satyavir Yadav, Sundeep Mishra, Rajeev Agarwala. (2021). Statins: The Backbone of Treatment of Dyslipidemia. American Journal of Internal Medicine, 9(2), 76-82. https://doi.org/10.11648/j.ajim.20210902.13

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    ACS Style

    Satyavir Yadav; Sundeep Mishra; Rajeev Agarwala. Statins: The Backbone of Treatment of Dyslipidemia. Am. J. Intern. Med. 2021, 9(2), 76-82. doi: 10.11648/j.ajim.20210902.13

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    AMA Style

    Satyavir Yadav, Sundeep Mishra, Rajeev Agarwala. Statins: The Backbone of Treatment of Dyslipidemia. Am J Intern Med. 2021;9(2):76-82. doi: 10.11648/j.ajim.20210902.13

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  • @article{10.11648/j.ajim.20210902.13,
      author = {Satyavir Yadav and Sundeep Mishra and Rajeev Agarwala},
      title = {Statins: The Backbone of Treatment of Dyslipidemia},
      journal = {American Journal of Internal Medicine},
      volume = {9},
      number = {2},
      pages = {76-82},
      doi = {10.11648/j.ajim.20210902.13},
      url = {https://doi.org/10.11648/j.ajim.20210902.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20210902.13},
      abstract = {Statins are a panacea for secondary prevention of atherosclerotic cardiovascular disease and primary prevention in high-risk individuals. They are very well tolerated and side effects like muscle toxicity and increased risk of new onset of diabetes are seen in a minority of cases. They are also recommended in diabetic patient because the benefit is many times more than the risk of diabetes. Statins reduce total cholesterol, LDL cholesterol, Apo B, non-HDL cholesterol, and triglycerides, and also increase high-density lipoprotein (HDL) cholesterol levels in most patients with hypercholesterolemia and combined hyperlipidemia. Statins are not indicated in individuals with Frederickson Class I and V hyperlipidemias. Extensive literature supports use of statins in coronary heart disease (CHD) patients for treatment of dyslipidemia and secondary prevention. It has also been recognized that in secondary prevention and ACS populations lower LDL may be better. Trials have compared moderate with more robust LDL-C reduction, using maximum doses of atorvastatin or simvastatin. Available statins differ in their ability to reduce atherogenic lipoproteins and raise the level of high-density lipoprotein (HDL) cholesterol. Depending on dose used and specific statin, LDL cholesterol reduction of 18% to 55% can be expected. Atorvastatin and rosuvastatin are the most potent statins for lowering LDL-C cholesterol levels, yielding average reductions that approach 50% for atorvastatin and exceed 50% for rosuvastatin at the highest dose. Reduction in triglycerides with statins ranges from 7% to 30%, and is higher in hypertriglyceridemic populations and at higher statin doses. HDL levels usually rise by 5% to 10%. No consistent dose response relationship between statin dose and degree of HDL increase is seen.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Statins: The Backbone of Treatment of Dyslipidemia
    AU  - Satyavir Yadav
    AU  - Sundeep Mishra
    AU  - Rajeev Agarwala
    Y1  - 2021/03/09
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ajim.20210902.13
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    AB  - Statins are a panacea for secondary prevention of atherosclerotic cardiovascular disease and primary prevention in high-risk individuals. They are very well tolerated and side effects like muscle toxicity and increased risk of new onset of diabetes are seen in a minority of cases. They are also recommended in diabetic patient because the benefit is many times more than the risk of diabetes. Statins reduce total cholesterol, LDL cholesterol, Apo B, non-HDL cholesterol, and triglycerides, and also increase high-density lipoprotein (HDL) cholesterol levels in most patients with hypercholesterolemia and combined hyperlipidemia. Statins are not indicated in individuals with Frederickson Class I and V hyperlipidemias. Extensive literature supports use of statins in coronary heart disease (CHD) patients for treatment of dyslipidemia and secondary prevention. It has also been recognized that in secondary prevention and ACS populations lower LDL may be better. Trials have compared moderate with more robust LDL-C reduction, using maximum doses of atorvastatin or simvastatin. Available statins differ in their ability to reduce atherogenic lipoproteins and raise the level of high-density lipoprotein (HDL) cholesterol. Depending on dose used and specific statin, LDL cholesterol reduction of 18% to 55% can be expected. Atorvastatin and rosuvastatin are the most potent statins for lowering LDL-C cholesterol levels, yielding average reductions that approach 50% for atorvastatin and exceed 50% for rosuvastatin at the highest dose. Reduction in triglycerides with statins ranges from 7% to 30%, and is higher in hypertriglyceridemic populations and at higher statin doses. HDL levels usually rise by 5% to 10%. No consistent dose response relationship between statin dose and degree of HDL increase is seen.
    VL  - 9
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Author Information
  • All India Institute of Medical Sciences, New Delhi, India

  • All India Institute of Medical Sciences, New Delhi, India

  • Jaswant Rai Specialty Hospital, Meerut, India

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