Hydroxymethylglutaryl-coenzyme A reductase inhibitor
Hydroxymethylglutaryl-coenzyme A reductase inhibitors, also called statins, are antilipemic agents "that inhibit HMG-CoA reductases, which reduce the chemical 3-hydroxy-3-methyl-glutaryl CoA. They have been shown to directly lower cholesterol synthesis.
Statin therapy benefited about 1 of every 24 diabetic patients who used the treatment for 5 years if they are similar to the patients in the meta-analysis by Kearney et al (number needed to treat is 24).
Patients with average LDL cholesterol levels
Statin therapy benefited about 1 of every 24 patients with LDL cholesterol that averaged 150 mg per deciliter who took lovastatin 20-40 mg daily for 5 years if they are similar to the patients in the AFCAPS/TexCAPS randomized controlled trial (number needed to treat is 24).
Patients with normal LDL cholesterol levels
Statin therapy benefited about 1 of every 170 patients with LDL cholesterol less than 130 mg per deciliter (3.4 mmol per liter) and high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher who took rosuvastatin 20 mg daily for 2 years if they are similar to the patients in the JUPITER randomized controlled trial (number needed to treat for two years is 170). The frequency of death from any cause fell from 2.8% to 2.2% (number needed to treat for two years is 180). However, this trial was stopped early after an interim analysis so it is likely that the result is exaggerated.
Drug toxicity is more likely to happen when statins are given with patients who are also taking inhibitors of the cytochrome P-450 isoenzyme 3A4. Examples are the macrolide antimicrobials clarithromycin or erythromycin (but not azithromycin).
- A meta-analysis of five randomized controlled trials that compared high and low doses of statins among 32,752 subjects with coronary artery disease found a significantly increased odds ratio of 1.12 (95% CI, 1.04-1.22; I(2) = 0%)
- A meta-analysis of 13 randomized controlled trials that compared statins to no statins among 91,140 subjects (with and without coronary artery disease), found a significantly increased odds ratio of 1.09 (95% CI, 1.02-1.17; I(2) = 11%) 
- A meta-analysis of four randomized controlled trials with 31,818 subjects without coronary artery disease found an insignificantly increased relative risk of 1.05 (95% CI, 0.84–1.32)
- Anonymous. Hydroxymethylglutaryl-coenzyme A reductase inhibitors. National Library of Medicine. Retrieved on 2008-01-18.
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