Blackmores Institute

<table><tbody><tr><td> Key Points - Statins are the most effective drug for atherosclerosis treatment and are commonly recommended for CVD prevention - Statins (Rosuvastatin and Atorvastatin) are ranked 1st and 2nd in the top ten most prescribed drugs in Australia 2020-2021 (combined prescription of 25 million for the last 12 months) - Statins work mainly by reducing cholesterol production through the mevalonate pathway - This same pathway also inhibits the production of the heart nutrient CoQ10 - Statins can have adverse effects - Different types of statins have different benefits and adverse effects - Atorvastatin and rosuvastatin are the most effective statins; however, atorvastatin is linked to liver dysfunction - Researchers state increased risks outweigh CVD reduction; however, clinical guidelines also state that lifestyle modification discussion is needed before statin treatment </td></tr></tbody></table> <h3>Statins and heart disease – the statistics</h3>The most recent Australian Burden of Disease Study (2018), reports that coronary heart disease is ranked as the number 1 cause of disease, even with incidences declining since 2003. These statistics also match Australia’s prescribing pattern. In the Australian 2020-2021 Top 10 Prescribed Drugs, two statins - Rosuvastatin and Atorvastatin - topped the rankings as 1st and 2nd, with a combined prescription count of over 25 million for the 12-month period. These same two statins have retained top places in the ranking for at least the last 5 years. <h3>How do statins work?</h3>Accumulation of cholesterol and low-density lipoprotein cholesterol (LDL cholesterol), with subsequent oxidation of LDLs and inflammation within vessel walls, are risk factors in cardiovascular disease and can lead to atherosclerosis. The main mechanisms of action of statins relates to their actions on LDL cholesterol reduction. They do this by competitively inhibiting the rate-limiting enzyme 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, which is necessary for the conversion of the substance mevalonate to cholesterol (as well as the production of the heart nutrient CoQ10). Hence statins are classed as HMG-CoA reductase drugs. This cholesterol producing biochemical pathway is called the mevalonate pathway.Statins may also extend their actions beyond lowering cholesterol levels, with some reducing inflammation by multiple mechanisms. For these reasons statins are the most used drugs to treat hyperlipidaemia. However, they also come with risks, including: <ul><li>muscle disorders</li><li>liver dysfunction</li><li>renal insufficiency</li><li>diabetes</li><li>eye conditions</li></ul><h3>Not all statins are the same</h3>There are different types of statins –hydrophilic (water-loving) and lipophilic (fat-loving). These different properties affect their pharmacokinetic properties and adverse effects. Hydrophilic statins (Pravastatin and Fluvastatin) do not penetrate the cell membrane easily so can have fewer actions but also less side effects compared to the lipophilic statins (Simvastatin, Lovastatin and Atorvastatin) Atorvastatin and Rosuvastatin are the most effective statins; however, Atorvastatin, for example, is linked specifically to liver dysfunction. Some statins can also cause increase, not decreases in inflammation.A recent review of statins and adverse events concluded that, “The increased risks did not outweigh the reduction in the risk of major cardiovascular events.” However, the National Institute for Health and Care Excellence (NICE) also recommends “GPs should discuss the benefits of changes to lifestyle with patients before initiating treatment with statins.” Sources:Top 10 drugs 2020-2021. Australian Prescriber. 2021; 44:205. https://www.nps.org.au/australian-prescriber/articles/top-10-drugs-2020-21 Australian Burden of Disease Study 2018: Interactive data on disease burden. Australian Institute of Health and Welfare. rel="noopener noreferrer" 2021. Viewed 22.12.2021, <a href="http://" target="_blank" style="">https://www.aihw.gov.au/reports/burden-of-disease/abds-2018-interactive-data-disease-burden/contents/leading-causes-of-disease-burden</a> Koushki K, et al.: Anti-inflammatory action of statins in cardiovascular disease: The role of inflammasome and toll-like receptor pathways. rel="noopener noreferrer" Clin Rev Allergy Immunol. 2021;60(2):175-199. <a href="https://link.springer.com/article/10.1007/s12016-020-08791-9" target="_blank" style="">DOI: 10.1007/s12016-020-08791-9</a> Cai T, et al.: Associations between statins and adverse events in primary prevention of cardiovascular disease: Systematic review rel="noopener noreferrer" with pairwise, network, and dose-response meta-analyses. BMJ. 2021:n1537. <a href="https://www.bmj.com/content/374/bmj.n1537" target="_blank" style="">DOI: 10.1136/bmj.n1537</a> NICE recommends wider use of statins for prevention of CVD. 2021. Viewed 23.12.21, https://www.nice.org.uk/news/article/nice-recommends-wider-use-of-statins-for-prevention-of-cvd

Statins are rated as one of the most effective classes of drugs for atherosclerosis treatment and cardiovascular (CVD) prevention. They work by lowering lipid levels and reducing inflammation. Although statins are low-cost options, they can have adverse health effects and need to be carefully weighed up against active lifestyle measures to prevent the high cardiovascular disease burden in Australia.

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