Last reviewed 04/2023
HMG CoA reductase inhibitors (statins) include:
- cerivastatin - marketing and distribution has been suspended in the UK and in all other countries where gemfibrozil is available because of concerns regarding the risk of rhabdomyolysis when these drugs are co-prescribed (1)
- inhibition of hydroxymethylglutaryl coenzyme A (HMG CoA) in the liver - the rate limiting step in cholesterol synthesis (approximately 50% of circulating cholesterol is endogenously synthesised, the remainder being derived directly or indirectly from the diet
- reduction in plasma cholesterol and LDL (statins alter the balance of cholesterol and cholesteryl ester within the hepatocyte and increase the removal of IDL and LDL, and decrease the production of VLDL and LDL)
- increase in LDL receptors
- small reduction in plasma triglyceride and VLDL
- modest increase in HDL (mechanism unknown)
Statins are the most potent drugs available for treating hypercholesterolaemia.
Statins are appropriately prescribed in the evening since the synthesis of cholesterol appears most active overnight (2).
The summary of product characteristics should be consulted before prescribing a particular statin.
efficacy of different statin drugs
statin treatment and coronary heart disease
statin treatment and cerebrovascular disease
hypercholesterolaemia - secondary prevention
primary prevention - high cholesterol
starting/monitoring statin therapy
myalgia and myositis associated with statin treatment
statin treatment and coenzyme Q10 (ubiquinone)
statin and fibrate combination therapy
statin treatment and cancer risk
NICE guidance - statins for the prevention of cardiovascular events
NICE guidance - statin treatment post myocardial infarction (MI)
water and lipid soluble statins