Major Clinical Outcomes
Statins are the most effective oral medications at lower LDL cholesterol levels (PCSK9 inhibitors are monoclonal antibodies are even more effective, but must be injected). Statins also moderately decrease triglyceride levels and raise HDL levels. Specifically, statins:
- Lower LDL-C by 20-50%
- Lower triglycerides by 10-20%
- Increase HDL by 5-10%
Statins have shown to decrease the following in multiple randomized controlled trials and associated meta-analyses:
- All-cause mortality
- Fatal and non-fatal cardiovascular events
- Fatal and non-fatal cerebrovascular events
Musculoskeletal side-effects of statins
Although muscle pain is one of the most frequently quoted side effects of statin drugs, the incidence is estimated to be low. Some literature reports up to 10% of statin takers have some form of myalgia. Fortunately, serious side effects such as rhabdomyolysis are extremely rare. High dose simvastatin has the strongest association of myopathy.
Rhabdomyolysis
Rhabdomyolysis is defined as 10 times increase of serum creatine kinase (CK) compared to baseline with associated renal dysfunction, myoglobinuria, and electrolyte imbalance (hyperkalemia).
Statin-associated rhabdomyolysis is extremely rare, with estimated rate of 0.01%- 0.02%.
Hepatic Dysfunction
Transient increase in liver enzymes can be noted in 1-3% of patients in the first 3 months of statin initiation. There is no evidence of long-term effects or damage.
Drug interactions with statins
Most statins are metabolized by the cytochrome P450 family enzymes. There are significant interactions with amiodarone, HIV medications, grapefruit, and some antibiotics. Pravastatin is an exception as it isn’t hepatically metabolized. Pravastatin is the first-line of choice in HIV and transplant patients.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126440/