Cochin Cardiac Club

Health Blog by Dr.Uday Nair


What are Statins and how do they work?

"Statins" are a class of drugs that lower the level of cholesterol in the blood by reducing the production of cholesterol by the liver. Statins block the enzyme in the liver that is responsible for making cholesterol. This enzyme is called hydroxy-methylglutaryl-coenzyme A reductase (HMG-CoA reductase). Scientifically, statins are referred to as HMG-CoA reductase inhibitors


What are the benefits of statins?

Most people think of statins primarily as cholesterol-lowering drugs. Statins improve blood cholesterol levels primarily by inhibiting a liver enzyme called HMG Co-A reductase, thus reducing the liver's ability to make cholesterol. Statins cause a significant reduction in LDL "bad" cholesterol levels, a moderate reduction in triglyceride levels, and a small increase in levels of HDL cholesterol ("good" cholesterol).
In addition to lowering cholesterol, however, statins have several other effects that are helpful in patients known or likely to have CAD(Coronary Artery Disease). These beneficial effects include:
  • Reducing the size of plaques in the arteries.
  • Stabilizing plaques, so they are less likely to rupture (and therefore less likely to cause acute heart attacks).
  • Reducing inflammation (which is now thought to be an important component of plaque formation and rupture).
  • Reducing CRP levels
  • Decreasing blood clot formation (Blood clot formation at the site of plaque rupture is the cause of most heart attacks).
  • Improving overall vascular function
In addition, studies have reported other possible benefits from statins, including a reduced incidence of Alzheimer's disease, particular benefits in diabetics, prevention of cataracts, and reducing blood pressure.


What conditions are statins used?

Statins are used for preventing and treating atherosclerosis that causes chest pain, heart attacks, strokes, and intermittent claudication in individuals who have or are at risk for atherosclerosis.
Risk factors for atherosclerosis include:
  • abnormally elevated cholesterol levels,
  • a family history of heart attacks (particularly at a young age),
  • increasing age, and
  • diabetes.
Most individuals are placed on statins because of high levels of cholesterol. Though reduction of cholesterol is important, heart disease is complex and, as discussed previously, other factors such as inflammation may play a role. Thirty-five percent of individuals who develop heart attacks do not have high blood cholesterol levels, yet most of them have atherosclerosis. This means that high levels of cholesterol are not always necessary for atherosclerotic plaques to form.

Because it is not clear which effect of statins is responsible for their benefits, the goal of treatment with statins should not be only the reduction of cholesterol to normal levels, but rather the prevention of the complications of atherosclerosis (angina, heart attacks, stroke, intermittent claudication, and death). This concept is important because it allows for individuals who have or are at risk for atherosclerosis, but do not have high levels of cholesterol, to be considered for treatment with statins. Statins, like angiotensin converting enzyme inhbitors (ACE inhibitors), are an important class of drugs because they have been shown to reduce the incidence of heart attacks, strokes, and death.

What are the different types of Statins-

Statins that are approved are:
  • atorvastatin ,
  • fluvastatin ,
  • lovastatin,
  • pravastatin,
  • rosuvastatin,
  • simvastatin,  and pitavastatin.     


  •  High dose statins eg,40-80mgs/day are recommended in acute coronary syndrome after coronary  interventions and especially when associated with diabetes.
  • Statins should be cautiously used when the liver enzymes are high,with fatty infiltration of liver .                                                                                                                                                                                                                                                                                                                                   

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