by Dr. Manura Nanayakkara

Created on: June 02, 2010   Last Updated: February 13, 2011

Statins are type of medications used to lower blood cholesterol levels and to correct lipid abnormalities. In addition, they are useful in patients with familial hypercholesterolemia, ischemic heart diseases, and diabetes mellitus.

Atorvastatin, Simvastatin, Lovastatin, Rosuvastatin, Fluvastatin, and Pravastains are examples. Common brands are Lipitor®, Zocor ®, Lescol ®, Crestor ®.

 Statins act by competitively inhibiting an enzyme called HMG CoA reductase. This enzyme is involved in cholesterol synthesis in the liver. Statins also lower LDL Cholesterol levels in blood, but they are less effective in reducing triglyceride concentration, than the drug type called fibrates (fenofibrate). In addition, evidence based studies have confirmed that the statins reduce deaths due to cardiovascular diseases such as myocardial infarctions.

How statins were discovered?

 Japanese scientists Akira Endo and Masao Karuda of Tokyo Japan found the first HMG CoA reductase inhibitor in 1971. This first molecule was called mevastatin, but it was not useful in humans. Then the pharmaceutical company, Merck & Co showed an interest in the Japanese research in 1976 and isolated the first statin useful in humans. It was named Lovastatin. 

What are the indications?

 Doctors consider giving statins to all patients with cardiovascular diseases with symptoms. These include angina, acute myocardial infarction, and stroke. Almost all patients above 40 years old with diabetes mellitus are also considered for treatment. However, in younger patients with diabetes mellitus, statins are usually given when there is poor sugar control, low HDL cholesterol (good cholesterol) and increased blood triglyceride concentration, hypertension, and family history of cardiovascular diseases.

 Before starting statin therapy, the patient should tell their doctor, whether he/she is having any of the following conditions. They are history of liver diseases, high alcohol intake, hypothyroidism, pregnancy, and breast feeding. Patients should not take alcohol when they are on statins.

 In addition, adequate contraception is needed during the course of this medication. If a patient is planning to get pregnant he/she must consult their doctor. Statins are also known to cause abnormalities in an unborn child. Patients should also avoid these drugs, when they are breast feeding their babies.    

 What are the side effects of statins?

 Most common side effects are nausea, vomiting, and intestinal disturbances. Very rarely these drugs can cause pancreatitis. In addition, these medications sometimes can cause inflammation of the muscles. This can lead to muscle pains.  Additionally, statins can cause a serious condition called rhabdomyolysis. However, rhabdomyolysis is fortunately very rare.

 Other important side effect is liver failure. This is also a rare side effect. This medication can alter liver function test results. Doctors usually do liver function tests (ALT Gamma GT, Serum Bilirubin) before starting statins, in order to get a baseline value.

If a patient develops severe vomiting, severe muscle pains, muscle weakness, yellowish discoloration of the body, severe loss of appetite and abdominal pain, while on statins, they should consult their doctor immediately.

 Sources

 British National Formulary

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