Statin

Statins (or HMG-CoA reductase inhibitors) are a class of medications that lower the concentration of cholesterol in the blood. They are typically prescribed to people who are at high risk of cardiovascular disease. Low-density lipoprotein (LDL) carriers of cholesterol play a key role in the development of atherosclerosis and coronary heart disease via the mechanisms described by the lipid hypothesis. As lipid-lowering medications, statins are effective in lowering apolipoprotein B and LDL cholesterol; they are widely used for primary prevention in people at high risk of cardiovascular disease, as well as in secondary prevention for those who have cardiovascular disease. Statins reduce the risk of myocardial infarction and stroke. Side effects of statins include an increased risk of muscle pain, a slightly increased risk of diabetes, and abnormal blood levels of certain liver enzymes in some people. Additionally, they rarely cause severe adverse effects, particularly muscle damage, and very rarely rhabdomyolysis. They act by inhibiting the enzyme HMG-CoA reductase, which plays a central role in cholesterol production. High cholesterol levels in the blood have been associated with cardiovascular disease. There are various statins, some of which include atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin. Combination preparations of a statin and another agent, such as ezetimibe/simvastatin, are also available. The class is on the World Health Organization's List of Essential Medicines with simvastatin being the listed medicine. In 2024, US sales were estimated at $5–6B, down from $19B in 2005. The best-selling statin is atorvastatin, also known as Lipitor, which in 2003 became the best-selling pharmaceutical in history at $12B in 2008. Patient compliance with statin usage is problematic despite robust evidence of their benefits.