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Use of statins Use reference from KDT

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Uses of statins

Statins are HMG-CoA reductase inhibitors. They lower hepatic cholesterol synthesis, increase hepatic LDL-receptor expression, and therefore produce a marked fall in LDL-cholesterol. They are first-line drugs for most patients requiring LDL reduction.

Drugs

Atorvastatin, rosuvastatin, simvastatin, pravastatin, fluvastatin, pitavastatin, and lovastatin.

Main clinical uses

  1. Primary hypercholesterolaemia
    • First-line therapy when LDL-C remains elevated despite diet, exercise, and correction of secondary causes.
    • Includes heterozygous familial hypercholesterolaemia.
    • High-intensity statins may be combined with ezetimibe or a PCSK9 inhibitor when LDL-C remains above the patient-specific target.
  2. Mixed dyslipidaemia
    • Used when raised LDL-C is associated with raised triglycerides.
    • They lower triglycerides moderately, especially when baseline triglycerides are high, but are not the primary drug for very severe hypertriglyceridaemia where prevention of pancreatitis is the immediate priority.
  3. Primary prevention of atherosclerotic cardiovascular disease (ASCVD)
    • To prevent first myocardial infarction, stroke, or other atherosclerotic event in people at sufficiently high cardiovascular risk.
    • Common groups include patients with diabetes mellitus, marked LDL-C elevation, chronic kidney disease, or high calculated ASCVD risk.
    • The decision is based on overall cardiovascular risk, not cholesterol value alone.
  4. Secondary prevention of ASCVD
    • Statins are indicated long term, usually at high intensity if tolerated, in patients with established:
      • Coronary artery disease or previous myocardial infarction
      • Acute coronary syndrome
      • Ischaemic stroke or transient ischaemic attack of atherosclerotic origin
      • Peripheral arterial disease
      • Previous coronary or peripheral revascularisation
  5. Diabetes mellitus
    • Used for cardiovascular-risk reduction in adults with type 1 or type 2 diabetes, particularly those aged 40 years or older or with additional risk factors.
  6. Chronic kidney disease
    • Often used for ASCVD prevention in non-dialysis CKD patients with elevated cardiovascular risk.
    • Starting statins routinely in patients already on maintenance dialysis has less certain benefit, though an existing statin is commonly continued unless contraindicated.
  7. Paediatric familial hypercholesterolaemia
    • Used, with specialist supervision, in children and adolescents with familial hypercholesterolaemia when lifestyle measures are inadequate.

Important practical point

Statins prevent cardiovascular events because of LDL-C lowering and plaque stabilisation. Contemporary guidance continues to regard statins as the foundation of lipid treatment in patients with established vascular disease, with non-statin treatment added when LDL-C lowering is inadequate. The ACC dyslipidaemia update describes this escalation approach.
Reference: K.D. Tripathi, Essentials of Medical Pharmacology, chapter on drugs used in dyslipidaemia / hypolipidaemic drugs. I do not have the specific KDT edition or its page numbering, so I cannot give a reliable page citation.
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