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Statin drugs are used to lower cholesterol in the body, actually body needs some cholesterol to work. If cholesterol level increases in blood it will stick to the walls of arteries and narrows or even block arteries. If a diet and exercise does not reduce cholesterol levels, then it will be necessary to take medicine. Often, this medicine is a statin. Statins lower LDL (bad) cholesterol levels and raise HDL (good) cholesterol levels. This will decrease the formation of plaques in arteries.
Statins are safe for most people. But these medicines are not recommended for pregnant patients and patients with chronic liver disease. They can also cause serious muscle problems. Some statins interact adversely with other drugs. This may result in fewer side effects.
If cholesterol levels are high in the body it causes coronary artery disease due to this fatty deposits builds up in the walls of arteries which are supplying blood to the heart. Often these deposits can harden and form plaques. Plaques are at risk of rupture, due to this undersurface of the artery lining is exposed, provoking an injury response. In this instance the blood flow through the artery can be blocked by the clot formation. By this, starving of muscle occurs due to inadequate supply of oxygen to heart muscles which may result in heart attack.Atherosclerosis process described above is predominantly a silent process with no symptoms. Although treatment for heart attacks has improved greatly over the years, a third of heart attack patients still die within 28 days, with the majority of these deaths occurring in the first 24 hours.
Statins has two main mechanisms of action. As per first mechanism, they stabilise plaques by making them less likely to rupture and therefore reducing the heart attacks. As per Second, they reduce the levels of cholesterol in the blood by inhibiting the enzyme in the liver that produces it. So less cholesterol level in the bloodstream means that there will be less deposition of plaques in walls of the artery. There are two types of cholesterol: HDL which is a “good”, cholesterol type; and LDL, the “bad “cholesterol type or disease-causing type. Cholesterol is measured in units called mmol/L, and a large meta-analysis was conducted in 20121 and concluded that for every 1 mmol/L drop in LDL (the “bad”) cholesterol, there was a reduction of 24% in the risk of heart attack, 15% in the risk of stroke, and 19% in the risk of death from coronary artery disease. The average patient on an appropriate statin at the correct dose might therefore expect their future cardiovascular risk to be halved.
All drugs have some benefits and some side effects. The most popular side-effect associated with statins is muscle pain, it is due to particular concern about a link between statins and a potentially fatal muscle condition called rhabdomyolysis. Many papers have examined the prevalence of this and have found it to be 1 in 10,000-100,000. In terms of general muscle aches and statin usage, and also other side-effects such as nausea, insomnia and fatigue, a 2014 review of statin studies conducted and they looked at the experiences of 83,000 people and concluded that almost all reported symptoms occurred just as frequently when patients were administered placebo 2 – in other words, the statin was not responsible.
Statins can, however, be incriminated in two areas: first drugs are given to 3% of patients they experienced rise in liver enzymes, and second there is a rate of developing diabetes is slightly higher in statin takers (3%) than in those taking placebo (2.4%)2. In asymptomatic patients it is unclear, whether the rise in liver enzymes is harmful, but many people naturally raised liver enzymes as a result of obesity or alcohol intake in any case, and in many instances the findings are dose-dependent such that lowering the statin dose results in normalisation of the liver enzymes. In terms of diabetes, the study found that only 1 in 5 new diagnoses of diabetes could be directly attributed to taking a statin. Although diabetes itself is a major risk factor for cardiovascular disease, the beneficial effect of the statin on the cardiovascular system is still felt to outweigh the risk posed to it by potentially provoking diabetes.
In 2014 the UK’s healthcare watchdog, NICE, issued guidance suggesting that the threshold for offering a statin to an individual should be reduced from a 20% risk of a cardiovascular event in the next 10 years to 10%. The percentage risk is calculated using a tool called the QRISK2, which takes into account many factors including age, blood pressure, smoking status and cholesterol. Statins have proven benefit in high-risk patients with established coronary artery disease, but concern was raised that in low risk populations the risk of side-effects and turning healthy people into “patients” outweighed the potential benefit. However, the 2012 report found that “reduction of LDL cholesterol with statin therapy significantly reduced the risk of major vascular events in individuals with 5-year risk lower than 10% […], even in those with no previous history of vascular disease”
Much controversy has also been created over statins and their link or otherwise to dementia. It has been suggested that confusion, memory loss and dementia are possible consequences of statin therapy but reports have been very variable, making it difficult for a true conclusion to be drawn. In 2000 two studies reported a lower risk of dementia in those using statins, but subsequent reports published mixed results, including favourable, unfavourable and neutral findings. More recently (20134) a systematic review and meta-analysis of the short and long-term cognitive effects of statins was undertaken, which found that short-term use of statins did not have any consistent effect in terms of confusion or memory loss. Furthermore long-term studies, encompassing 23,443 patients with an average exposure to statin therapy from 3 to 24.9 years, found no association between statin use and increased risk of dementia. 5 trials even found a favourable effect, and pooling the trial results revealed a 29% reduction in the risk of dementia in statin-treated patients.
1. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Cholesterol Treatment Trialists’ (CTT) Collaborators. Lancet. 2012 Aug 11; 380(9841):581-590
2. What proportion of symptomatic side-effects in patients taking statins are genuinely caused by the drug? Systematic review of randomized placebo-controlled trials to aid individual patient choice. Finegold JA, Manisty CH, Goldacre B, Barron A, Francis D. European Journal of Preventive Cardiology. 2014, Vol 21(4) 464-474
3. Statins in the treatment of dyslipidaemia in the presence of elevated liver aminotransferase levels: a therapeutic dilemma. Calderon R, Cubeddu L, Goldberg R, Schiff E. Mayo Clin Proc. 2010 Apr; 85(4): 349-356
4. Statins and cognition: a systematic review and meta-analysis of short and long-term cognitive effects. Swiger KJ et al. Mayo Clin Proc 2013 Nov;88(11):1213-21
5. Side effects of statin use and focus on rhabdomyolysis. ESC Council for Cardiology Practice. Vol 12, no 28-29 July 2014
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