Statiny

Cor Vasa 2002, 43(11):493-496

Statins "the year after". A review of statin therapy after the "cerivastatin" scandal. Are all statins equal?

Richard Češka: Centrum preventivní kardiologie, III. interní klinika, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

The occurrence of side effects, and myopathy in particular, including fatalities, resulted in the withdrawal of cerivastatin from the international market a year ago. The reports also sparkled debate on the approprieteness of statin use as well as whether all statins are equal in terms of their efficacy and, in particular, their safety.
First, it should be noted that the benefits offered by statins to millions of patients worldwide clearly outweigh the potential risks associated with this therapy. The effects of statins have been tested in interventional studies involving dozens of thousands of individuals. Interestingly, no case of severe rhabdomyolysis has been reported from these interventional studies. This comes as just another piece of evidence showing the huge benefits derived by patients from participating in clinical trials with closely monitored therapy. The benefit for cardiovascular morbidity and mortality in these trials has been widely reported so there is no need to re-emphasize it.
Differences in the metabolization of various statins are reviewed as are endpoints in terms of drug safety, especially so in combination therapy and, most importantly, in specific patient populations such as transplant recipients and patients receiving immunosuppression. Attention is also partly given to combination therapy with lipid-lowering agents, and to combinations of statins and fibrates.