Statins: Difference between revisions
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== Introduction == | == Introduction == | ||
[[File:Statin.png|thumb|474x474px|Schematic mechanism of action of statins]] | [[File:Statin.png|thumb|474x474px|Schematic mechanism of action of statins]] | ||
Statin medications are a class of [[Lipids|lipid]]-lowering medications that decrease illness and mortality in those who are at high risk of [[Cardiovascular Disease|cardiovascular disease]], being the most common cholesterol-lowering drugs<ref>Sizar O, Khare S, Jamil RT, Talati R. [https://www.ncbi.nlm.nih.gov/books/NBK430940/ Statin medications.] | Statin medications are a class of [[Lipids|lipid]]-lowering medications that decrease illness and mortality in those who are at high risk of [[Cardiovascular Disease|cardiovascular disease]], being the most common cholesterol-lowering drugs<ref name=":0">Sizar O, Khare S, Jamil RT, Talati R. [https://www.ncbi.nlm.nih.gov/books/NBK430940/ Statin medications.] StatPearls [Internet]. 2024.https://www.ncbi.nlm.nih.gov/books/NBK430940/</ref>. | ||
# Statins are | # Statins are 3-hydroxyl-3-methylglutaryl coenzyme A reductase (HMG-CoA Reductase) inhibitors. Statins competitively inhibit HMG-CoA reductase, which limits the rate of cholesterol synthesis (primarily in the liver). As a result, statins break down LDL, decrease the synthesis of VLDL, and increase HDL. Through this mechanism, statins can reduce the amount of plaque that forms in the arteries (see '''[[Atherosclerosis]]''' for more information). <ref name=":1">Bansal AB, Cassagnol M. HMG-CoA Reductase Inhibitors. StatPearls [Internet]. 2024. Available from: [[/www.ncbi.nlm.nih.gov/books/NBK542212/|https://www.ncbi.nlm.nih.gov/books/NBK542212/]]</ref> | ||
# Statins may also inhibit many of the structural and functional components of the [[Atherosclerosis|arteriosclerotic]] process. Structural effects include reductions in vascular [[Muscle: Smooth|smooth muscle]] hypertrophy and proliferation, fibrin deposition, and collagen cross-linking. Among the functional effects are improvements in [[Reticuloendothelial System|endothelial function,]] reduction in inflammatory [[cytokines]] and [[Free Radicals|reactive oxygen species]], and down-regulation of [[Angiotensin Inhibitors and Blockers for Treating Hypertension|angiotensin]] II and endothelin receptors.<ref>Mangat S, Agarwal S, Rosendorff C. [https://journals.sagepub.com/doi/abs/10.1177/1074248407300380 Do statins lower blood pressure?]. Journal of cardiovascular pharmacology and therapeutics. 2007 Jun;12(2):112-23.Available: https://journals.sagepub.com/doi/abs/10.1177/1074248407300380<nowiki/>(accessed 9.4.2022)</ref> | # Statins may also inhibit many of the structural and functional components of the [[Atherosclerosis|arteriosclerotic]] process. Structural effects include reductions in vascular [[Muscle: Smooth|smooth muscle]] hypertrophy and proliferation, fibrin deposition, and collagen cross-linking. Among the functional effects are improvements in [[Reticuloendothelial System|endothelial function,]] vasodilation due to increased nitric oxide production, reduction in inflammatory [[cytokines]] and [[Free Radicals|reactive oxygen species]], and down-regulation of [[Angiotensin Inhibitors and Blockers for Treating Hypertension|angiotensin]] II and endothelin receptors.<ref>Mangat S, Agarwal S, Rosendorff C. [https://journals.sagepub.com/doi/abs/10.1177/1074248407300380 Do statins lower blood pressure?]. Journal of cardiovascular pharmacology and therapeutics. 2007 Jun;12(2):112-23.Available: https://journals.sagepub.com/doi/abs/10.1177/1074248407300380<nowiki/>(accessed 9.4.2022)</ref> | ||
There are several different types of statins. The main difference between them is their potency. | There are several different types of statins. The main difference between them is their potency. | ||
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== Uses == | == Uses == | ||
[[File:Atherosclerosis diagram.png|thumb|221x221px|Atherosclerosis diagram]] | [[File:Atherosclerosis diagram.png|thumb|221x221px|Atherosclerosis diagram]] | ||
Clinicians use statin medications for the treatment of | Clinicians use statin medications for the treatment of: | ||
* [[Hypercholesterolemia]], | * [[Hypercholesterolemia]], | ||
* [[Hyperlipidemia|Hyperlipoproteinemia]] | * [[Hyperlipidemia|Hyperlipoproteinemia]] | ||
* Hypertriglyceridemia | * Hypertriglyceridemia | ||
* [[Hyperlipidemia]] | |||
* [[Atherosclerosis]] | * [[Atherosclerosis]] | ||
* [[Myocardial Infarction|Myocardial infarction]] prophylaxis | * [[Myocardial Infarction|Myocardial infarction]] prophylaxis | ||
* [[Stroke]] prophylaxis | * [[Stroke]] prophylaxis <ref name=":0" /> <ref name=":1" /> | ||
== Brief Literature Review == | |||
== Adverse Effects == | == Adverse Effects == | ||
Revision as of 04:42, 1 May 2024
Original Editor - Lucinda hampton
Top Contributors - Lucinda hampton and Mason Trauger
Introduction[edit | edit source]
Statin medications are a class of lipid-lowering medications that decrease illness and mortality in those who are at high risk of cardiovascular disease, being the most common cholesterol-lowering drugs[1].
- Statins are 3-hydroxyl-3-methylglutaryl coenzyme A reductase (HMG-CoA Reductase) inhibitors. Statins competitively inhibit HMG-CoA reductase, which limits the rate of cholesterol synthesis (primarily in the liver). As a result, statins break down LDL, decrease the synthesis of VLDL, and increase HDL. Through this mechanism, statins can reduce the amount of plaque that forms in the arteries (see Atherosclerosis for more information). [2]
- Statins may also inhibit many of the structural and functional components of the arteriosclerotic process. Structural effects include reductions in vascular smooth muscle hypertrophy and proliferation, fibrin deposition, and collagen cross-linking. Among the functional effects are improvements in endothelial function, vasodilation due to increased nitric oxide production, reduction in inflammatory cytokines and reactive oxygen species, and down-regulation of angiotensin II and endothelin receptors.[3]
There are several different types of statins. The main difference between them is their potency.
Uses[edit | edit source]
Clinicians use statin medications for the treatment of:
- Hypercholesterolemia,
- Hyperlipoproteinemia
- Hypertriglyceridemia
- Hyperlipidemia
- Atherosclerosis
- Myocardial infarction prophylaxis
- Stroke prophylaxis [1] [2]
Brief Literature Review[edit | edit source]
Adverse Effects[edit | edit source]
Statins are usually well-tolerated, with myositis, rhabdomyolysis, hepatotoxicity, and diabetes mellitus being the most common adverse reactions.
- The incidence of myopathy is dose-dependent and may present as diffuse myalgias or otherwise unexplainable muscle tenderness or weakness that may reverse upon medication discontinuation.
- Rhabdomyolysis is the most serious complication of statin use, but its occurrence is rare.
- Statin-associated immune-mediated necrotizing myopathy(IMNM) can occur due to the development of antibodies against the HMG-CoA reductase enzyme. Symmetrical, proximal muscle weakness with significantly increased creatine phosphokinase (CPK) that continues for months after ceasing statins is common in IMNM[4]
Avoid mixing statins with grapefruit. Grapefruit causes an increase to the side effect of the drugs. This could put you at risk for muscle breakdown, liver damage, and kidney failure. More mild cases can cause pain in the joints and muscles.
Smoking cigarettes should also be avoided when taking statins. Smoking decreases the positive effects of statins. Smokers had a 74 to 86 % higher risk of events[5].
Physiotherapy Implications[edit | edit source]
Statins may increase the incidence of exercise-related muscle complaints and in some studies augment the exercise-induced rise in muscle enzymes, but statins do not consistently reduce muscle strength, endurance, overall exercise performance or physical activity.[6]
References[edit | edit source]
- ↑ 1.0 1.1 Sizar O, Khare S, Jamil RT, Talati R. Statin medications. StatPearls [Internet]. 2024.https://www.ncbi.nlm.nih.gov/books/NBK430940/
- ↑ 2.0 2.1 Bansal AB, Cassagnol M. HMG-CoA Reductase Inhibitors. StatPearls [Internet]. 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542212/
- ↑ Mangat S, Agarwal S, Rosendorff C. Do statins lower blood pressure?. Journal of cardiovascular pharmacology and therapeutics. 2007 Jun;12(2):112-23.Available: https://journals.sagepub.com/doi/abs/10.1177/1074248407300380(accessed 9.4.2022)
- ↑ Sizar O, Khare S, Jamil RT, Talati R. Statin medications.Available:https://www.ncbi.nlm.nih.gov/books/NBK430940/ (accessed 4.2.2024)
- ↑ Healthline Will Statins Lower My Blood Pressure? Available: https://www.healthline.com/health/statins-will-they-lower-my-blood-pressure (accessed 9.4.2022)
- ↑ Noyes AM, Thompson PD. The effects of statins on exercise and physical activity. Journal of clinical lipidology. 2017 Sep 1;11(5):1134-44. Available: https://pubmed.ncbi.nlm.nih.gov/28807461/(accessed 9.4.2022)
