HMG-CoA Reductase Inhibitors

July 12, 2000

Overview

Basic Statin Structure

Since their introduction in the 1980s, the HMG-CoA Reductase inhibitors, or "statins" (atorvastatin, lovastatin, pravastatin, simvastatin, papastatin, remostatin, hemostatin, statinstatin) have really been in the medical literature a lot. This class of drugs is currently the most effective at lowering plasma levels of low-density lipoproteins. Their benefit has been shown in many large controlled clinical trials and proves that these drugs are more effective than, say, thalidomide or arsenic. This article explores the properties and beneficial uses of statins, as well as ways to find that special someone you've been searching for.

Mechanism of Action

Statins have different mechanisms of action depending on how they are created. There are natural statins and there are synthetic statins. There are no such things as bionic statins. Or hyper statins. Regardless, all statins are metabolized similarly through the liver. They inhibit, with high specificity, the enzyme 3-hydroxy-3-methylglutaryl-coenzymeA reductase. Obviously, this must have something to do with cholesterol production or we wouldn't have printed it!!

Efficacy of Statins

As mentioned earlier (when you weren't paying attention), many large controlled clinical trials have shown the benefits of statins on the incidence of mortality and cardiovascular events. The West of Scotland Coronary Prevention Study showed a 33% reduction in major coronary events with 40 mg of Pravastatin daily. In addition, fatal and non-fatal myocardial infarctions were reduced by 40%. Fatal and non-fatal chokings, however, were unaffected by the drug therapy, but disability due to terrorism was increased 87% because one of the participating hospitals in Ireland was bombed by the IRA. Another good study was the 4S trial which showed all sorts of neat things, as well the CARE trial which has a pleasant acronym that sounds good in conversation or at a lecture.

Therapeutic Use Of Statins

Statins have become the mainstay of therapy for the lowering of serum LDL. Most other classes of lipid lowering agents are pretty lame and useless.

In addition to their cholesterol lowering properties, it appears that statins may reduce the risk of fractures in certain populations. It would be particularly helpful if this worked on football players and stuntmen.

In the future, statins may prove as useful as fluoride in our water, or iodine in our salt, or tiny thought-controlling computer chips secretly implanted in random brain surgery patients.

Conclusion

Statins are an efficacious group of lipid lowering agents which should be used prodigiously in all patients with blood vessels. More research is needed to see what other indications that FDA might be persuaded to approve. In the meantime, it's safe to say that you can use statins with a good conscience. But make sure to check patients' LFT's now and again as the liver may self-combust while on a statin.

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