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Review: Statins do not increase minor or serious symptomatic adverse events in placebo-controlled trials

Ann Intern Med. 2014;161(2):JC3. doi:10.7326/0003-4819-161-2-201407150-02003
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More statin prescription leads to better cardiovascular prevention
Posted on July 23, 2014
Gauranga C. Dhar
Bangladesh Institute of family Medicine and Research
Conflict of Interest: None Declared
As a result of recent ACC/AHA guidelines, number of statin prescriptions is dramatically increased both in developed and developing countries. As per guidelines, once statin is started, this drug should be continued lifelong e.g. there is no specific target like <70mg/dl or <100mg/dl. Statin is no more confined to a drug class “lipid lowering” but due to pleiotropic effects, statin is used for many indications beyond lipid lowering. Statins reduce oxidative stress, reduce pro-inflammatory cytokines, reverse endothelial dysfunction and so on. By stimulating eNOS, statin increases nitric oxide bioavailability. By reducing endothelin-1 (ET-1) statin reduces vasoconstriction. Statin reduces tromboxane A2. Although there are evidences that statin use leads to hyperglycemia but hyperglycemia outweighs vascular benefit e.g. reduction of cardiovascular morbidity and mortality. On the other hand, patients with cardiometabolic diseases suffer from vascular fragility. Some adverse effects like myotoxicity/rhabdomyolysis or hepatotoxicity are really found very rare in clinical practice.
As a result of present study and other studies and guidelines, I think physician should be more bold to prescribe statin both in primary and secondary cardiovascular prevention as statin related adverse effects are very rare as usually thought.
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