Pacerone (amiodarone) package insert. N Engl J Med. N Engl J Med. For the purpose of this guideline, statins are grouped into 3 different intensity categories according to the percentage reduction in low density lipoprotein cholesterol: a 20% to 30% reduction is low intensity. By inhibiting this enzyme, cholesterol and LDL-cholesterol production is decreased. Statins differ in their potency at lowering total cholesterol, triglycerides, LDL-cholesterol, or increasing HDL-cholesterol; their propensity for drug interactions; and their reported safety in people with kidney disease. 2017;376:1713-1722.30. Statins may also affect some diabetes markers (such as HbA1c or fasting glucose), and may not be suitable in those with liver or kidney disease. Accessed March 18, 2018.22. Statins have been shown to increase the risk of diabetes development, although several important caveats exist.50 First, although this can be considered something of a class effect, the true risk of each specific statin is still unknown.51,52 In the largest meta-analysis to date, pravastatin had the lowest risk, simvastatin and atorvastatin had a moderate risk, and rosuvastatin had the highest risk of causing new-onset diabetes.53 None of these findings was statistically significant, however.53 Additionally, the finding that diabetes risk increases as the dose of statin increases has been inconsistent.54, Statin-induced diabetes is most prevalent in persons already at high risk for developing diabetes.50,54 This includes older patients and those with prediabetes or metabolic syndrome.50,55 One consistent finding has been that, for each new case of incident diabetes caused by statins, several CVEs can be prevented in higher-risk patients.50 Therefore, pharmacists should counsel anxious statin users at moderate or high risk for CV complications that the risk of developing diabetes is more than offset by the CV risk-reduction benefits. Is alternate daily dose of atorvastatin effective in treating patients with hyperlipidemia? The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. These include the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline and the 2017 American Academy of Clinical Endocrinology (AACE) guideline.14,20 Both guidelines suggest that after implementation of lifestyle modifications, including smoking cessation, adhering to an exercise regimen, and following a heart-healthy diet, statins are first-line therapy for both primary and secondary prevention of CV disease (CVD).14,20 The guidelines differ, however, in how to determine which statins are appropriate for which patients. 2015;90:24-34.47. Recommendations for management of clinically significant drug-drug interactions with statins and select agents used in patients with cardiovascular disease: a scientific statement from the American Heart Association. Lowering cholesterol and other types of fats is important because research has shown that elevated levels of total cholesterol, LDL-cholesterol, triglycerides, and apolipoprotein B increase a person’s risk of developing heart disease or having a stroke. When a statin is suspected as the cause of mild-to-moderate symptoms, temporary withdrawal is recommended. Patients aged 40 to 75 years with diabetes but no history of an ASCVD event, and an LDL-C level between 70 and 189 mg/dL.4. The Alternate Day Versus Daily Dosing of Atorvastatin Study (ADDAS). American College of Cardiology. Am J Cardiol. 2015;36:1012-1022.42. This article, which focuses on generic statins, will highlight the debate about statins’ role in therapy, discuss proper use, and explore evidence surrounding two major adverse events. Statins are generally safe when used at recommended dosages. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. a 31% to 40% reduction is medium intensity. However, the risk-benefit ratio is unclear in patients with a very low risk of CVEs.50. Atorvastatin and fluvastatin are preferred in people with kidney disease. Crandall JP, Mather K, Rajpathak SN, et al. Mild muscle pain is a common side effect of statins. Although most statins may be taken without regard to meals, immediate-release (IR) lovastatin should be taken with the evening meal because of increased bioavailability.4 However, the opposite is true for extended-release lovastatin, which should not be taken with food owing to decreased bioavailability.8 Further, although all statins may be dosed once daily, IR fluvastatin and lovastatin may require twice-daily dosing.3,4 Finally, whereas atorvastatin, pravastatin, and rosuvastatin may be administered at any time of day, fluvastatin, lovastatin, and simvastatin should be taken in the evening.3,4,7 Simvastatin, in particular, was shown to have significantly different efficacy when taken in the evening as opposed to the morning.32. Ridker PM, Danielson E, Fonseca FA, et al. Some statins, particularly those metabolized by CYP 3A4 (such as atorvastatin, pravastatin and simvastatin), can interact with several other drugs, such as clarithromycin, protease inhibitors, cyclosporine, gemfibrozil, oral contraceptives, and digoxin. Eur Heart J. Patients with prior atherosclerotic CVD (ASCVD), including those with a prior event (i.e., acute coronary syndromes, history of myocardial infarction, stable or unstable angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease of presumed atherosclerotic origin).2. Maple Grove, MN: Upsher-Smith Laboratories LLC; July 2017.35. Zhang H, Plutzky J, Shubina M, Turchin A. 2011;377:2181-2192.19. Individuals are then classified into one of five risk groups, each with a corresponding LDL-C and non–HDL-C goal (TABLE 4). Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Available for Android and iOS devices. For a complete list of severe side effects, please refer to the individual drug monographs. Practical aspects in the management of statin-associated muscle symptoms (SAMS). Atheroscler Suppl. Serious muscle effects have been reported with statins, including rhabdomyolysis – this is the destruction of muscle cells. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Accessed March 18, 2018.46. 1. Cannon CP, Braunwald E, McCabe CH, et al. Most of the effects of statins, including the blocking of the HMG-CoA reductase enzyme) occur in the liver. N Engl J Med. Ganda OP. Stroes ES, Thompson PD, Corsini A, et al. 2015;32:649-661.25. Grapefruit juice should be avoided with these statins. a reduction of more than 40% is high intensity. www.acc.org/latest-in-cardiology/articles/2018/03/05/15/53/sat-9am-odyssey-outcomes-cv-outcomes-with-alirocumab-after-acs-acc-2018. East Hanover, NJ: Novartis Pharmaceuticals Corp; August 2017.4. These symptoms typically resolve with discontinuation. N Engl J Med. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. Atorvastatin and simvastatin produce the greatest percentage change in LDL cholesterol levels. Meta-analysis of placebo-controlled randomized controlled trials on the prevalence of statin intolerance. Dosage adjustment may be needed based on renal function, race, or drug interactions. ** Rosuvastatin levels are about 50% higher in hemodialysis patients vs patients with normal renal function. Statin-induced diabetes: incidence, mechanisms, and implications. Wallace A, Chinn D, Rubin G. Taking simvastatin in the morning compared with in the evening: randomised controlled trial. Although statin therapy is not without risks, its benefits in reducing CV outcomes have made it the cornerstone of CVE prevention. People with active liver disease or who are pregnant or breastfeeding should not take statins. 2012;380:581-590.18. Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid-Lowering Arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase. Some statins may not be suitable for some people including those with a recent history of stroke or transient ischemic attack (TIA). Rarely, statins can cause more-serious side effects such as: Increased blood sugar or type 2 diabetes. Circulation. Lloyd-Jones DM, Morris PB, Ballantyne CM, et al. Available guidelines differ widely, but the one constant is that statins should be first-line therapy for primary and secondary prevention in nearly every patient. The cornerstone of dyslipidemia treatment involves the use of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, more commonly known as statins. Statin Dose Comparison.
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