Overview

Statins are a class of drugs known as HMG‑CoA reductase inhibitors. They are widely prescribed to lower low-density lipoprotein (LDL) cholesterol levels and prevent cardiovascular events like heart attack and stroke. :contentReference[oaicite:1]{index=1}

Medical Uses

Statins are used for both primary and secondary prevention of cardiovascular disease. They reduce LDL cholesterol and stabilize plaque in blood vessels, lowering the risk of myocardial infarction and stroke. :contentReference[oaicite:2]{index=2}

Atorvastatin (Lipitor), the most prescribed statin globally, has over 100 million prescriptions annually. :contentReference[oaicite:3]{index=3}

Side Effects & Safety

• Muscle pain (myalgia): Common, affecting up to 10%–15% of users; rarely progresses to rhabdomyolysis. :contentReference[oaicite:4]{index=4}
• Increased risk of type 2 diabetes: Small rise in risk has been observed. :contentReference[oaicite:5]{index=5}
• Mild liver enzyme elevation: Occurs in about 0.5%–2% but usually non-clinical. :contentReference[oaicite:6]{index=6}
• Cognitive concerns: No strong evidence linking statins to meaningful cognitive decline. :contentReference[oaicite:7]{index=7}

Recent meta‑analyses suggest that most perceived side effects are no more frequent than placebo. Studies show <10% muscle complaints due to statins. :contentReference[oaicite:8]{index=8}

Mechanism of Action

Statins inhibit HMG‑CoA reductase, a key enzyme in the cholesterol synthesis pathway in the liver. This decreases internal cholesterol production and upregulates LDL receptors, increasing clearance from the bloodstream. :contentReference[oaicite:9]{index=9}

Drug Interactions

• Grapefruit juice can dramatically increase statin levels (especially simvastatin), raising risk of toxicity. :contentReference[oaicite:10]{index=10}
• Concurrent use with fibrates or niacin increases risk of rhabdomyolysis. :contentReference[oaicite:11]{index=11}
• CYP3A4 inhibitors (e.g., macrolide antibiotics, protease inhibitors) can elevate statin levels. :contentReference[oaicite:12]{index=12}

Special Precautions

• Avoid statins in pregnancy and breastfeeding. :contentReference[oaicite:13]{index=13}
• Use lower doses or prefer pravastatin/fluvastatin if taking amiodarone, verapamil, or diltiazem. :contentReference[oaicite:14]{index=14}
• Caution in patients with liver or kidney disease.

References

1. Statins: Harvard Health overview. :contentReference[oaicite:15]{index=15}

2. Clinical data on atorvastatin usage and safety. :contentReference[oaicite:16]{index=16}

3. Meta-analyses on statin side effects and benefits. :contentReference[oaicite:17]{index=17}