Pharmacology of Statins: MedTweetorial on Mechanisms, Benefits, and Risks

Unlocking insights on statins: efficacy, dosage, adverse effects, and management...

• Mechanism ⚙️: Statins inhibit HMG-CoA reductase, reducing cholesterol synthesis in hepatocytes. They also increase LDL receptors and act on VLDL.
• Efficacy 💊: LDL ↓ 30–40%, HDL ↑ 5–15%, Triglycerides ↓ 10–30% (with ezetimibe/resin).
• Dosage: Adjust according to lipid response. Atorvastatin 10–80 mg/day, Fluvastatin (20–) 40–80 mg/day, Lovastatin 20–80 mg/day, Pravastatin 20–40 mg/day, Simvastatin 10–40 mg/day, Rosuvastatin 10–40 mg/day.
• Adverse Effects ⚠️: Well tolerated in elderly, ↑ Aminotransferases < 2%, usually not clinically significant, Muscle pain 5–10%, severe < 0.1%, No routine CK tests..
• Risk factors for myopathy: concomitant drugs, genetics, advanced age, diseases, surgery, hypothyroidism, vit D deficiency.
• Management of Muscle Symptoms 🚨: ↓ dose, switch statin/metabolic pathway, combo with ezetimibe, consider other drugs (e.g. PCSK9 inhibitors).
• 🩺 Risks: Slight ↑ diabetes risk, No association with polyneuropathy, pancreatitis, cognitive effects, or cataracts.

References

1. Rosenson RS. Statins: Actions, side effects, and administration. In: UpToDate, Connor RF (Ed), Wolters Kluwer. https://www.uptodate.com/contents/statins-actions-side-effects-and-administration.
2. Sizar O, Khare S, Patel P, et al. Statin Medications. [Updated 2024 Feb 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430940.