The safety of statins in clinical practice

@article{Armitage2007TheSO,
  title={The safety of statins in clinical practice},
  author={Jane Armitage},
  journal={The Lancet},
  year={2007},
  volume={370},
  pages={1781-1790}
}
  • J. Armitage
  • Published 24 November 2007
  • Medicine
  • The Lancet

Tables from this paper

Safety of statins: an update
Statins are widely used and have been proven to be effective in the prevention of atherosclerotic vascular disease events, primarily by reducing plasma low-density lipoprotein cholesterol
Non-cardiovascular effects associated with statins
TLDR
Current systematic reviews and clinical practice guidelines indicate that the cardiovascular benefits of statins generally outweigh non-cardiovascular harms in patients above a certain threshold of cardiovascular risk.
Dyslipidemia: Treatment in Statin – Intolerant Patients
TLDR
The first step in handling intolerant patients is to rule out any secondary causes of myopathy or liver toxicity, and the use of non-lipid lowering drugs, such as ezetimibe, bile acids sequestrants and fibrates, alone or in combination are considered.
Statins in the treatment of dyslipidemia in the presence of elevated liver aminotransferase levels: a therapeutic dilemma.
TLDR
This review supports the use of statin treatment in patients with high cardiovascular risk whose elevated aminotransferase levels have no clinical relevance or are attributable to known stable chronic liver conditions.
Statin safety and chronic liver disease
TLDR
There are an increasing number of referrals to both lipid and liver clinics regarding the use of statins in the setting of chronic liver disease and also the cause of elevated liver enzymes in patients who are on statins, and current prescribing strategies in these two patient populations are clarified.
Safety of statins
TLDR
Understanding of the mechanisms behind adverse effects of statins including an insight into the pharmacokinetic properties have minimised fear of statin use among clinicians and awareness of drugs interacting with statins and knowledge of certain combinations together with monitoring of altered creatine kinase activity may greatly minimise associated adverse effects.
Molecular mechanisms of statin intolerance
TLDR
In the case of most patients, it seems that mild-to-moderate abnormalities in liver and muscle enzymes are not serious adverse effects and do not outweigh the benefits of coronary heart disease risk reduction.
Risk identification and possible countermeasures for muscle adverse effects during statin therapy.
Management of statin intolerance
TLDR
Though statin intolerance has considerably impacted cardiovascular outcomes in the high-risk patients, it has been well effectively managed by prescribing statins either as alternate-day or once weekly dosage regimen, as combination therapy with a non-statin therapy or and by dietary intervention.
Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association
TLDR
In patients for whom statin treatment is recommended by current guidelines, the benefits greatly outweigh the risks, and the difference in the incidence of muscle symptoms without significantly raised creatinine kinase in statin-treated compared with placebo-treated participants is <1%, suggesting that muscle symptoms are usually not caused by pharmacological effects of the statin.
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References

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