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January 2017

Perspective on Trends in Statin Use

Author Affiliations
  • 1Christian Care Health System, Newark, Delaware

Copyright 2016 American Medical Association. All Rights Reserved.

JAMA Cardiol. 2017;2(1):11-12. doi:10.1001/jamacardio.2016.4710

Since their introduction in the 1990s, statins have become the most common class of prescription medications in the United States.1 Statins work by blocking the critical pathway in the synthesis of cholesterol in the liver. This leads to increased expression of the low-density lipoprotein (LDL) receptor and a significant reduction in LDL cholesterol. Elevated LDL cholesterol level can be considered a true surrogate for downstream development of cardiovascular events.2 Multiple agents have been shown to reduce events in proportion to LDL reduction.3 Multiple clinical trials and meta-analyses have conclusively demonstrated that therapy with statins in appropriate patients will reduce cardiovascular events.4 The patients appropriate for statin therapy have been broadened from secondary prevention in patients with prior cardiovascular events to primary prevention in patients at elevated risk.5 While there have been some concerns over myalgias and a slight increase in the incidence of type 2 diabetes, statins have proven to be safe and effective.6 Statins also have proven to be cost-effective in appropriate patients (ie, providing good value), using generally accepted willingness-to-pay thresholds.7 The most recent guidelines for lipid-lowering therapy would also increase the number of patients considered appropriate for statin therapy.5 Nonetheless, there has been concern about the cost to society of prescribing a medication so widely.