Statins in afya

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beware reversible myositis (esp if hypothyroid or renal failure)
SE - headache, GI, altered LFT

''inhibit action of HMG-CoA reductase'' (rate-limiting enzyme in hepatic cholesterol synthesis)

''Side effects''
//myopathy// (myalgia, myositis, rhabdomyolysis and asymptomatic raised creatine kinase)
esp if older, female, low BMI, multi-system disease eg DM
more with lipophilic (simva, atorva) than hydrophilic (rosuva, prava, fluva)
//liver impairment// NICE 2008 - do LFT - baseline, 3 and 12/12 - stop Rx if transaminase rise //and persist// at 3x upper limit normal 
risk //intracerebral haemorrhage// ?inc if previous stroke - not seen in primary prevention - avoid statins in those with Hx of intracerebral haemorrhage

''Who ?''
all with established CVD (stroke, TIA, IHD, PAD)
anyone with 10-year CVS risk >= 20%
T2DM - previously all >40 had statin, now if >40  and any CVD risk (smoke, weight BMI, CVS score 20%) then statin)

take at night (most cholesterol synthesis occurs then) - esp if simva as short half life

''Targets''
Primary - fire and forget - ie no target
secondary ...
||Total cholesterol (mmol/l)|LDL cholesterol|
|Joint British Societies|< 4.0|< 2.0|
|National Service Framework for CHD|< 5.0|< 3.0|
|SIGN 2007|< 5.0|< 3.0|

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