What is the likelihood that a patient will benefit from statins?
Among the recommendations was that people 40 to 75 years of age without clinical ASCVD and diabetes should take statins if they have an LDL cholesterol level of 70 to 189 mg/dL and an estimated 10-year ASCVD risk of 7.5% or more. The guidelines also included methods for making this risk estimate.
What are the USPSTF guidelines on statins and risk factors for CVD?
Dec 12, 2018 · In the US about 10% of patients prescribed statin therapy stop their medication due to subjective complaints, most often due to muscle symptoms without a rise in creatine kinase. This is in contrast to randomized clinical trials in which the excess incidence of muscle symptoms without enzyme elevation due to statins is less than 1%.
What are the effects of statin therapy?
Mar 21, 2022 · In conclusion, we propose that “statin intolerance” be defined as “in the individual case treated with statins for the first time, in whom statin continuation becomes difficult due to an adverse event (e.g., elevated muscle enzymes, deteriorated renal function, abnormal liver function test results, subjective symptoms suggesting statins as the cause like myopathy) …
What is clinically significant statin hepatotoxicity?
Aug 31, 2020 · Expected Benefits of Statin Use. The next phase should be the transition from treatment decisions based on short-term risk to long-term expected benefit. 7,8 The expected benefit is dependent on multiple factors, including the underlying cardiovascular risk, the amount of low-density lipoprotein lowering that can be achieved, and the remaining life expectancy. 7,8
What is the criteria for statin therapy?
What is an important recommendation regarding the use of a statin?
What's an important precaution when taking statin drugs?
What is a statin indicated condition?
LDL ≥ 5.0 mmol/L (or ApoB ≥1.45 g/L or non-HDL ≥5.8mmol/L) (familial hypercholesterolemia or genetic dyslipidemia) chronic kidney disease (GFR <60 and/or urine ACR ≥3 mg/mmol for at least 3 months), excluding patients on chronic dialysis.Apr 30, 2021
When are statins recommended?
What is statin therapy for patients with cardiovascular disease?
What are statin contraindications?
What is the most common side effect of statins?
What are the pros and cons of taking statin drugs?
What are the new guidelines for cholesterol levels?
How do statins work mechanism?
Statins work by competitively blocking the active site of the first and key rate-limiting enzyme in the mevalonate pathway, HMG-CoA reductase. Inhibition of this site prevents substrate access, thereby blocking the conversion of HMG-CoA to mevalonic acid.Jan 17, 2019
What are the new guidelines for cholesterol levels Canada?
What is the bioavailability of statins?
Drug-Drug Interactions. All statins undergo hepatic first-pass metabolism, which accounts for their low bioavailability (as low as 5%), though notably pitavastatin has the highest bioavailability of the class at 50%.
Do statins affect steroidogenesis?
As inhibitors of steroid biosynthesis, a statin's theoretical effect on steroid hormone production and function has been investigated. Statins have minimal if any clinically relevant effect on steroidogenesis. Levels and rhythms of ACTH, cortisol, LH and FSH seem unaffected.
Why do people stop statins?
In the US about 10% of patients prescribed statin therapy stop their medication due to subjective complaints, most often due to muscle symptoms without a rise in creatine kinase. This is in contrast to randomized clinical trials in which the excess incidence of muscle symptoms without enzyme elevation due to statins is less than 1%. Although few drugs have adverse effects on skeletal muscle, all statins have been implicated as causing myopathy. These symptoms are typically bilateral and symmetrical and always confined to skeletal muscle.
Can statins cause myopathy?
Although few drugs have adverse effects on skeletal muscle, all statins have been implicated as causing myopathy. These symptoms are typically bilateral and symmetrical and always confined to skeletal muscle.
Does statin therapy cause diabetes?
One interpretation is that statin therapy accelerates the onset of diabetes amongst those most at risk for insulin resistance. What remains unclear is whether the duration of statin therapy affects this possible risk; whether the diabetogenic effect of statins would be reversible at all is an active area of research.
Do statins increase risk of diabetes?
The increased risk of diabetes appears highest for a population similarly at risk for CVD (preexisting obesity, metabolic syndrome). Since statins are well established to substantially reduce cardiovascular events in those with and without diabetes, there is no reason to stop therapy.
What is the function of statins?
Liver Function. Statins act in the liver to inhibit HMG-CoA reductase which temporarily de pletes intracellular cholesterol and in turn induces production of LDL receptors. Statins have liver effects that range from mild transaminase elevation to very rare hepatotoxicity with severe liver injury.
The Current Paradigm
Atherosclerosis does not affect all of us, and does not affect all those struck by it to the same extent or at similar age.
Expected Benefits of Statin Use
The next phase should be the transition from treatment decisions based on short-term risk to long-term expected benefit. 7, 8 The expected benefit is dependent on multiple factors, including the underlying cardiovascular risk, the amount of low-density lipoprotein lowering that can be achieved, and the remaining life expectancy. 7, 8
Remaining Uncertainties
Whereas advancing age is consistently associated with increasing short-term cardiovascular risk, the inverse is true for its relation with expected benefit of statin use for primary prevention of ASCVD.
The Road Forward
Some uncertainties regarding statin use in primary prevention of ASCVD will be clarified in the years to come, and some will never be removed. The work by Pencina and colleagues 9 is an important step in restructuring our collective thinking regarding cholesterol management in primary prevention of ASCVD.
Disclosures
Dr Leening reports receiving research grants from the Albert Schweitzer Hospital Research Fund, the Oncology Research Albert Schweitzer Foundation, and the Promoting Advanced Cardiology through Education Foundation, all outside the submitted work.
Footnotes
The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
What is the risk of statins for CVD?
Adults with diabetes or dyslipidemia and a 20% or greater 10-year CVD event risk are most likely to benefit from statin use. Clinicians may selectively offer adults who smoke or have dyslipidemia, diabetes, or hypertension and a 7.5% to 10% 10-year CV D event risk a low- to moderate-dose statin.
What is the purpose of statins?
Statins are a class of lipid-lowering medications that function by inhibiting the enzyme 3-hydroxy-3-methyl-glutaryl coenzyme A reductase. Statins reduce levels of total cholesterol and LDL-C and, to a lesser extent, triglycerides.
What is the risk of CVD in a 10 year old?
Grade. Adults aged 40 to 75 years with no history of CVD, 1 or more CVD risk factors, and a calculated 10-year CVD event risk of 10% or greater. The USPSTF recommends that adults without a history of cardiovascular disease (CVD) (ie, symptomatic coronary artery disease or ischemic stroke) use a low- to moderate-dose statin for the prevention ...
Is statin good for CVD?
Although statin use may be beneficial for the primary prevention of CVD events in some adults with a 10-year CVD event risk of less than 10%, the likelihood of benefit is smaller, because of a lower probability of disease and uncertainty in individual risk prediction. Clinicians may choose to offer a low- to moderate-dose statin to certain adults ...
Do statins lower cholesterol?
Statins reduce levels of total cholesterol and LDL-C and, to a lesser extent, triglycerides. The most directly applicable body of evidence for patients without a history of CVD demonstrates benefits with use of low- to moderate-dose statins. Considerations for Implementation.
Is the USPSTF independent of the government?
Recommendations made by the US PSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
When will statins be updated?
Written by Shawn Radcliffe — Updated on April 16, 2020. A year after the release of new guidelines for treating high cholesterol, doctors and patients are still confused about just who needs to take statin drugs. Last fall, the American College of Cardiology (ACC) and the American Heart Association ...
Can statins cause memory loss?
Statins are not without side effects. These include muscle pain, confusion, flushing, and rarely liver damage or memory loss. Statins and Diabetes Risk: What You Need to Know ». The guidelines are clear about which groups of people could benefit most from therapy — both medications like statins and lifestyle changes like eating better ...
Do you need to monitor LDL levels after statin?
Another aspect of the guidelines that has created some confusion is the belief that, because there are no more LDL targets, doctors no longer need to do ongoing monitoring of LDL blood levels after a patient starts taking a statin. This is not the case.
What is the AHA guidelines?
Last fall, the American College of Cardiology (ACC) and the American Heart Association (AHA) released new guidelines for the treatment of cholesterol to prevent heart attacks and strokes, amid a continuing rise in the rate of heart disease in the Unit ed States. Though the guidelines were years in the making and have received a large amount ...
What is risk management?
Risk management, rather than focusing solely on lowering cholesterol, means looking at someone’s entire risk profile, which includes whether they have high blood pressure or established heart disease, are current or former smokers, or have a strong family history of the disease.