title: Safety of statins: an update.
abstract: Statins are widely used and have been proven to be effective in the prevention of atherosclerotic vascular disease events, primarily by reducing plasma low-density lipoprotein cholesterol concentrations. Although statins are generally well tolerated and present an excellent safety profile, adverse effects from muscle toxicity and liver enzyme abnormalities may occur in some patients. Myopathy and rhabdomyolysis are rare with statin monotherapy at the approved dose ranges, but the risk increases with use of higher doses, interacting drugs and genetic predisposition. Asymptomatic increases in liver transaminases with statin treatment do not seem to be associated with an increased risk of liver disease. Therefore, statin treatment can be safely used in patients with mild to moderately abnormal liver tests that are potentially attributable to nonalcoholic fatty liver disease and can improve liver tests and reduce cardiovascular morbidity in this group of patients. The risks of other unfavorable effects such as the slightly increased risk of new-onset diabetes and potentially increased risk of haemorrhagic stroke are much smaller than the cardiovascular benefits with the use of statins.
authors.affiliation: Division of Clinical Pharmacology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: Miao
authors.initials: M
authors.lastname: Hu
authors.affiliation: Division of Clinical Pharmacology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: Bernard M Y
authors.initials: BM
authors.lastname: Cheung
authors.affiliation: Division of Clinical Pharmacology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: Brian
authors.initials: B
authors.lastname: Tomlinson
keywords: cardiovascular disease; drug safety; myopathy; rhabdomyolysis; statins
references.citation: Circulation. 2006 Dec 19;114(25):2788-97
references.pmid: 17159064
references.citation: Curr Opin Lipidol. 2011 Dec;22(6):460-6
references.pmid: 21897230
references.citation: Curr Med Chem. 2008;15(23):2380-92
references.pmid: 18855667
references.citation: Ann Pharmacother. 2002 Feb;36(2):288-95
references.pmid: 11847951
references.citation: J Am Coll Cardiol. 2010 Jan 19;55(3):198-211
references.pmid: 20117400
references.citation: Neurology. 2008 Jun 10;70(24 Pt 2):2364-70
references.pmid: 18077795
references.citation: Pharmacogenet Genomics. 2005 Jun;15(6):415-21
references.pmid: 15900215
references.citation: Exp Gerontol. 2006 Aug;41(8):746-52
references.pmid: 16797903
references.citation: JAMA. 2003 Apr 2;289(13):1681-90
references.pmid: 12672737
references.citation: Am J Cardiol. 2006 Apr 17;97(8A):6C-26C
references.pmid: 16581330
references.citation: Am J Cardiol. 2006 Apr 17;97(8A):89C-94C
references.pmid: 16581336
references.citation: Transl Res. 2009 Jan;153(1):11-6
references.pmid: 19100953
references.citation: Nat Rev Endocrinol. 2009 Sep;5(9):507-18
references.pmid: 19636324
references.citation: Am J Cardiol. 2006 Apr 17;97(8A):27C-31C
references.pmid: 16581325
references.citation: Am J Cardiovasc Drugs. 2011;11(2):93-107
references.pmid: 21446776
references.citation: Expert Opin Drug Saf. 2011 Nov;10(6):969-86
references.pmid: 21999163
references.citation: Am J Cardiol. 2002 Nov 20;90(10B):50K-60K
references.pmid: 12467940
references.citation: Lancet. 2007 Jan 20;369(9557):201-7
references.pmid: 17240286
references.citation: J Am Coll Cardiol. 2002 Aug 7;40(3):567-72
references.pmid: 12142128
references.citation: Am J Cardiol. 2006 Apr 17;97(8A):69C-76C
references.pmid: 16581332
references.citation: JAMA. 2011 Jun 22;305(24):2556-64
references.pmid: 21693744
references.citation: Curr Med Res Opin. 2011 Aug;27(8):1551-62
references.pmid: 21682551
references.citation: Expert Opin Drug Saf. 2010 Jul;9(4):667-74
references.pmid: 20553090
references.citation: Ther Adv Cardiovasc Dis. 2008 Jun;2(3):157-66
references.pmid: 19124419
references.citation: Arch Neurol. 2012 Jan;69(1):39-45
references.pmid: 21911657
references.citation: Am J Cardiol. 2005 Sep 5;96(5A):69F-75F
references.pmid: 16126026
references.citation: Circulation. 2009 Apr 28;119(16):2136-45
references.pmid: 19364982
references.citation: Hepatology. 2008 Aug;48(2):662-9
references.pmid: 18666246
references.citation: Lancet. 2010 Dec 4;376(9756):1916-22
references.pmid: 21109302
references.citation: N Engl J Med. 2008 Aug 21;359(8):789-99
references.pmid: 18650507
references.citation: Expert Opin Drug Saf. 2011 May;10(3):373-87
references.pmid: 21342078
references.citation: Am J Cardiol. 2007 Feb 1;99(3):379-81
references.pmid: 17261402
references.citation: N Engl J Med. 2008 Nov 20;359(21):2195-207
references.pmid: 18997196
references.citation: Cardiovasc Drugs Ther. 2009 Aug;23(4):295-9
references.pmid: 19543962
references.citation: Am J Cardiol. 2007 Apr 1;99(7):903-5
references.pmid: 17398180
references.citation: Curr Opin Cardiol. 2010 Jul;25(4):406-10
references.pmid: 20375883
references.citation: Am J Cardiol. 2006 Jan 1;97(1):61-7
references.pmid: 16377285
references.citation: N Engl J Med. 2005 Apr 7;352(14):1425-35
references.pmid: 15755765
references.citation: Curr Opin Lipidol. 2008 Dec;19(6):558-62
references.pmid: 18957877
references.citation: Lancet Neurol. 2009 May;8(5):453-63
references.pmid: 19375663
references.citation: N Engl J Med. 2006 Aug 10;355(6):549-59
references.pmid: 16899775
references.citation: Lancet. 2005 Oct 8;366(9493):1267-78
references.pmid: 16214597
references.citation: Curr Treat Options Cardiovasc Med. 2009 Aug;11(4):272-8
references.pmid: 19627660
references.citation: Clin Pharmacol Ther. 2005 Nov;78(5):551-8
references.pmid: 16321621
references.citation: Lancet. 2004 Mar 6;363(9411):757-67
references.pmid: 15016485
references.citation: BMJ. 2003 Jun 28;326(7404):1423
references.pmid: 12829554
references.citation: Expert Opin Drug Metab Toxicol. 2011 Jan;7(1):49-62
references.pmid: 21091277
references.citation: Expert Opin Drug Metab Toxicol. 2009 Jul;5(7):703-29
references.pmid: 19442037
references.citation: Lancet. 2010 Feb 27;375(9716):735-42
references.pmid: 20167359
references.citation: Am J Cardiol. 2003 Aug 21;92(4B):23K-29K
references.pmid: 12948873
references.citation: Curr Med Res Opin. 2011 Sep;27(9):1683-90
references.pmid: 21728907
references.citation: Pharmacogenomics J. 2010 Feb;10(1):1-11
references.pmid: 19884908
references.citation: Curr Opin Cardiol. 2011 Jul;26(4):342-7
references.pmid: 21499090
references.citation: Pharmacotherapy. 2006 Nov;26(11):1601-7
references.pmid: 17064205
references.citation: Pharmacogenet Genomics. 2006 Dec;16(12):873-9
references.pmid: 17108811
references.citation: Clin Pharmacol Ther. 2010 Jan;87(1):130-3
references.pmid: 19890253
references.citation: Circulation. 2004 Jun 15;109(23 Suppl 1):III50-7
references.pmid: 15198967
references.citation: Lancet. 2010 Nov 13;376(9753):1658-69
references.pmid: 21067805
references.citation: Ann Pharmacother. 2009 Dec;43(12):2012-20
references.pmid: 19920157
references.citation: Clin Pharmacol Ther. 2006 Dec;80(6):565-81
references.pmid: 17178259
references.citation: CMAJ. 2008 Feb 26;178(5):576-84
references.pmid: 18299547
references.citation: Neurology. 2004 Nov 23;63(10):1868-75
references.pmid: 15557504
references.citation: Med Hypotheses. 2011 Oct;77(4):658-61
references.pmid: 21802861
references.citation: Int J Endocrinol. 2010;2010:957174
references.pmid: 20016680
references.citation: Clin Endocrinol (Oxf). 2009 Jul;71(1):154-5
references.pmid: 19178510
references.citation: Circulation. 2010 Jan 5;121(1):143-50
references.pmid: 20026779
references.citation: Curr Opin Cardiol. 2011 Jul;26(4):338-41
references.pmid: 21499089
references.citation: Lipids Health Dis. 2007 Mar 21;6:7
references.pmid: 17376224
references.citation: Cardiovasc Ther. 2012 Oct;30(5):e212-8
references.pmid: 21884002
references.citation: Ann Intern Med. 2009 Jun 16;150(12):858-68
references.pmid: 19528564
references.citation: Lancet. 2004 Jun 26;363(9427):2189-90
references.pmid: 15220045
references.citation: Am J Cardiol. 2006 Apr 17;97(8A):52C-60C
references.pmid: 16581329
references.citation: Genome Med. 2009 Dec 29;1(12):120
references.pmid: 20090898
references.citation: Osteoporos Int. 2006;17(8):1133-40
references.pmid: 16718398
references.citation: Evid Based Med. 2010 Jun;15(3):84-5
references.pmid: 20522688
references.citation: Curr Opin Lipidol. 2011 Dec;22(6):489-96
references.pmid: 21986643
references.citation: Cardiovasc Drugs Ther. 2005 Dec;19(6):403-14
references.pmid: 16453090
references.citation: Drug Saf. 2010 Mar 1;33(3):171-87
references.pmid: 20158283
references.citation: Am J Cardiol. 2007 Nov 1;100(9):1400-3
references.pmid: 17950797
references.citation: Cardiology. 2007;107(4):433-43
references.pmid: 17363845
references.citation: Circulation. 2011 Nov 15;124(20):2233-42
references.pmid: 22007076
references.citation: Clin Pharmacol Ther. 2011 Feb;89(2):210-6
references.pmid: 21178985
references.citation: J Am Coll Cardiol. 2007 Jun 12;49(23):2231-7
references.pmid: 17560286
references.citation: J Am Coll Cardiol. 2009 Oct 20;54(17):1609-16
references.pmid: 19833260
references.citation: Lancet. 2007 Nov 24;370(9601):1781-90
references.pmid: 17559928
references.citation: Hepatology. 2007 Nov;46(5):1453-63
references.pmid: 17668878
references.citation: Cardiol Rev. 2008 Jul-Aug;16(4):205-12
references.pmid: 18562811
references.citation: Am Fam Physician. 2011 Mar 15;83(6):711-6
references.pmid: 21404982
references.citation: Expert Opin Drug Metab Toxicol. 2008 Jun;4(6):821-5
references.pmid: 18611121
references.citation: Curr Drug Saf. 2009 Sep;4(3):209-28
references.pmid: 19534648
references.citation: Lancet. 2010 Nov 13;376(9753):1670-81
references.pmid: 21067804
references.citation: Lancet. 2008 Jan 12;371(9607):117-25
references.pmid: 18191683
references.citation: Stroke. 2008 Jun;39(6):1668-74
references.pmid: 18309149