Statins

Question 1

What do statins inhibit?

Answer 1

HMG-CoA reductase

(enzyme that limits hepatic choelsterol synthesis)

Question 2

What are some adverse side effects of statins?

Answer 2

1. Myopathy (Myalgia, myositis, rhabdomyolysis and raised CK)
2. Liver impairment - check LFTS 3 and 12 months.
3. Intracerebral haemorrhage if previously had a stroke.

Question 3

In what type of statins is myopathy more common with?

Answer 3

Lipophilic statins (simvastatin or atorvastatin)

Not so much with hydrophilic statins (rosuvastatin, pravastatin or fluvastatin)

Question 4

When should statins be stopped regarding serum transaminases and liver impairment?

Answer 4

If ALT or AST rise to 3 times the upper limit of the reference range.

Question 5

What are some risk factors that can cause people to develop myopathy with statin use?

Answer 5

• Female sex
• Advanced age
• Low BMI
• Multisystem disease like DM.

Question 6

Who does the Royal College of Physicians recommend avoiding statins in and why?

Answer 6

People with a history of intracerebral haemorrhage because of the increased risk of intracerebral haemorrhage in patients who have previously had a stroke.

Question 7

Are intracerebral haemorrhages seen in patient who are being treated for primary prevention?

Answer 7

No

Question 8

Who should receive a statin?

Answer 8

• All people with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease)
• NICE recommend anyone with a 10-year cardiovascular risk >= 10%
• Patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins

Question 9

When should statins be taken and why?

Answer 9

At night because this is when the majority of cholesterol synthesis occurs.

Question 10

NICe don’t have any targets for cholesterol and LDL levels. What do the Joint British Societies recommend we lower it to?

Answer 10

Total cholesterol <4.0 mmol/l

LDL cholesterol <2.0 mmol/l