Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. - PubMed - NCBI
Statins are the most powerful drugs available for lowering LDL-C and are the most effective lipid lowering drugs for improving clinical outcomes when used for primary and secondary prevention of cardiovascular disease. The choice of statin depends upon a number of factors, including the degree of hyperlipidemia, pharmacokinetic properties, drug interactions, the presence of renal impairment, and cost.
Rosuvastatin, atorvastatin, and simvastatin cause the greatest percentage change in LDL-C; they are preferred in patients who require a potent statin because of high cardiovascular risk or who require >35 percent reduction in LDL-C.
In patients with severe renal impairment, we suggest treatment with atorvastatin or fluvastatin (Grade 2C). These medications do not require dose adjustment.
In patients with chronic liver disease who require a statin because of high cardiovascular risk, we suggest complete abstinence from alcohol and the use of pravastatin at a low dose (Grade 2C).
Fewer pharmacokinetic drug interactions are likely to occur with pravastatin, fluvastatin, rosuvastatin, and pitavastatin because they are not metabolized through the CYP3A4．
There are no clear data that the adverse event profile differs significantly among statins. However, pravastatin and fluvastatin appear less likely to cause muscle toxicity than other statins.
We suggest not routinely monitoring serum creatine kinase (CK), but it is useful to obtain a baseline CK level for reference purposes prior to starting statin therapy. Patients treated with statins should be alerted to report the new onset of myalgias or weakness.
We suggest checking baseline aminotransferase levels prior to initiating statin therapy; routine monitoring of these levels is not necessary for patients on statins.
We suggest checking a TSH level prior to initiating statin therapy.