Effects of statins on lipoprotein fractions

Hydroxy-methyl-glutaryl CoA (HMG-CoA) reductase inhibitors, known also as "statins": atorvastatin, cerivastatin, fluvastatin, lovastatin, pravastatin and simvastatin, are powerful hypolipidemic agents which often enable physicians to attain target values, as established by the NCEP guidelines, especially when a marked and consistent reduction in LDL cholesterol is necessary. With the exception of cerivastatin which was recently withdrawn from worldwide sale because of the worrying incidence of fatal cases of rhabdomyolysis possibly due to high dosages and concomitant use of other drugs such as gemfibrozil or cyclosporin, statins are safe in the long term, as demonstrated by their widespread use in the past 15 years and recently by large-scale clinical trials like the Heart Protection Study. Amongst the currently available statins atorvastatin, extended release fluvastatin and simvastatin have a major effect in lowering LDL cholesterol. Nevertheless, some physicochemical and especially pharmacokinetic differences between the various strains of statins might influence the choice of a particular one as treatment option for an individual patient and might explain some differences that have been described when effects other than the specific hypocholesterolemic one are concerned. These include a possible different action on circulating HDL cholesterol and may be on other systems of biological and physiopathological relevance in the determinism of atherosclerosis and its complications. (C) 2003 Published by Elsevier Science B.V.