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id="toc-Primary_prevention-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Secondary_prevention" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Secondary_prevention"> <div class="vector-toc-text"> 1.2 Secondary prevention </div> </a> <ul id="toc-Secondary_prevention-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Statin_product_offerings_-_comparative_effectiveness" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Statin_product_offerings_-_comparative_effectiveness"> <div class="vector-toc-text"> 1.3 Statin product offerings - comparative effectiveness </div> </a> <ul id="toc-Statin_product_offerings_-_comparative_effectiveness-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Women_and_children" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Women_and_children"> <div class="vector-toc-text"> 1.4 Women and children </div> </a> <ul id="toc-Women_and_children-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Familial_hypercholesterolemia" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Familial_hypercholesterolemia"> <div class="vector-toc-text"> 1.5 Familial hypercholesterolemia </div> </a> <ul id="toc-Familial_hypercholesterolemia-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Contrast-induced_nephropathy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Contrast-induced_nephropathy"> <div class="vector-toc-text"> 1.6 Contrast-induced nephropathy </div> </a> <ul id="toc-Contrast-induced_nephropathy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Chronic_kidney_disease" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Chronic_kidney_disease"> <div class="vector-toc-text"> 1.7 Chronic kidney disease </div> </a> <ul id="toc-Chronic_kidney_disease-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Adverse_effects" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Adverse_effects"> <div class="vector-toc-text"> 2 Adverse effects </div> </a> <button aria-controls="toc-Adverse_effects-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Adverse effects subsection </button> <ul id="toc-Adverse_effects-sublist" class="vector-toc-list"> <li id="toc-Cognitive_effects" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Cognitive_effects"> <div class="vector-toc-text"> 2.1 Cognitive effects </div> </a> <ul id="toc-Cognitive_effects-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Muscles" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Muscles"> <div class="vector-toc-text"> 2.2 Muscles </div> </a> <ul id="toc-Muscles-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Diabetes" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Diabetes"> <div class="vector-toc-text"> 2.3 Diabetes </div> </a> <ul id="toc-Diabetes-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Cancer" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Cancer"> <div class="vector-toc-text"> 2.4 Cancer </div> </a> <ul id="toc-Cancer-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Drug_interactions" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Drug_interactions"> <div class="vector-toc-text"> 2.5 Drug interactions </div> </a> <ul id="toc-Drug_interactions-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Osteoporosis_and_fractures" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Osteoporosis_and_fractures"> <div class="vector-toc-text"> 2.6 Osteoporosis and fractures </div> </a> <ul id="toc-Osteoporosis_and_fractures-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Mechanism_of_action" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Mechanism_of_action"> <div class="vector-toc-text"> 3 Mechanism of action </div> </a> <button aria-controls="toc-Mechanism_of_action-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> Toggle Mechanism of action subsection </button> <ul id="toc-Mechanism_of_action-sublist" class="vector-toc-list"> <li id="toc-Inhibiting_cholesterol_synthesis" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Inhibiting_cholesterol_synthesis"> <div class="vector-toc-text"> 3.1 Inhibiting cholesterol synthesis </div> </a> <ul id="toc-Inhibiting_cholesterol_synthesis-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Increasing_LDL_uptake" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Increasing_LDL_uptake"> <div class="vector-toc-text"> 3.2 Increasing LDL uptake </div> </a> <ul id="toc-Increasing_LDL_uptake-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Decreasing_of_specific_protein_prenylation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Decreasing_of_specific_protein_prenylation"> <div class="vector-toc-text"> 3.3 Decreasing of specific protein prenylation </div> </a> <ul id="toc-Decreasing_of_specific_protein_prenylation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Other_effects" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Other_effects"> <div class="vector-toc-text"> 3.4 Other effects </div> </a> <ul id="toc-Other_effects-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Available_forms" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Available_forms"> <div class="vector-toc-text"> 4 Available forms </div> </a> <ul id="toc-Available_forms-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> 5 History </div> </a> <ul id="toc-History-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Research" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Research"> <div class="vector-toc-text"> 6 Research </div> </a> <ul id="toc-Research-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> 7 References </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> 8 External links </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" > Toggle the table of contents </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading">Statin</h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 48 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-48" aria-hidden="true" > 48 languages </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%B3%D8%AA%D8%A7%D8%AA%D9%8A%D9%86" title="ستاتين – Arabic" lang="ar" hreflang="ar" data-title="ستاتين" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target">العربية</a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/Statinl%C9%99r" title="Statinlər – Azerbaijani" lang="az" hreflang="az" data-title="Statinlər" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target">Azərbaycanca</a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Statin" title="Statin – Bosnian" lang="bs" hreflang="bs" data-title="Statin" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target">Bosanski</a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Estatina" title="Estatina – Catalan" lang="ca" hreflang="ca" data-title="Estatina" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target">Català</a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Statin" title="Statin – Czech" lang="cs" hreflang="cs" data-title="Statin" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target">Čeština</a></li><li class="interlanguage-link interwiki-cy mw-list-item"><a href="https://cy.wikipedia.org/wiki/Statinau" title="Statinau – Welsh" lang="cy" hreflang="cy" data-title="Statinau" data-language-autonym="Cymraeg" data-language-local-name="Welsh" class="interlanguage-link-target">Cymraeg</a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Statin" title="Statin – Danish" lang="da" hreflang="da" data-title="Statin" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target">Dansk</a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Statin" title="Statin – German" lang="de" hreflang="de" data-title="Statin" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target">Deutsch</a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Statiinid" title="Statiinid – Estonian" lang="et" hreflang="et" data-title="Statiinid" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target">Eesti</a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%A3%CF%84%CE%B1%CF%84%CE%AF%CE%BD%CE%B5%CF%82" title="Στατίνες – Greek" lang="el" hreflang="el" data-title="Στατίνες" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target">Ελληνικά</a></li><li class="interlanguage-link interwiki-es badge-Q17437798 badge-goodarticle mw-list-item" title="good article badge"><a href="https://es.wikipedia.org/wiki/Estatina" title="Estatina – Spanish" lang="es" hreflang="es" data-title="Estatina" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target">Español</a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Statino" title="Statino – Esperanto" lang="eo" hreflang="eo" data-title="Statino" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target">Esperanto</a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Estatina" title="Estatina – Basque" lang="eu" hreflang="eu" data-title="Estatina" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target">Euskara</a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%A7%D8%B3%D8%AA%D8%A7%D8%AA%DB%8C%D9%86_(%D8%AF%D8%A7%D8%B1%D9%88)" title="استاتین (دارو) – Persian" lang="fa" hreflang="fa" data-title="استاتین (دارو)" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target">فارسی</a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Statine" title="Statine – French" lang="fr" hreflang="fr" data-title="Statine" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target">Français</a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Estatina" title="Estatina – Galician" lang="gl" hreflang="gl" data-title="Estatina" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target">Galego</a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EC%8A%A4%ED%83%80%ED%8B%B4" title="스타틴 – Korean" lang="ko" hreflang="ko" data-title="스타틴" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target">한국어</a></li><li class="interlanguage-link interwiki-ha mw-list-item"><a href="https://ha.wikipedia.org/wiki/Statin" title="Statin – Hausa" lang="ha" hreflang="ha" data-title="Statin" data-language-autonym="Hausa" data-language-local-name="Hausa" class="interlanguage-link-target">Hausa</a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D5%8D%D5%BF%D5%A1%D5%BF%D5%AB%D5%B6" title="Ստատին – Armenian" lang="hy" hreflang="hy" data-title="Ստատին" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target">Հայերեն</a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Statin" title="Statin – Croatian" lang="hr" hreflang="hr" data-title="Statin" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target">Hrvatski</a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Statin" title="Statin – Indonesian" lang="id" hreflang="id" data-title="Statin" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target">Bahasa Indonesia</a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Statine" title="Statine – Italian" lang="it" hreflang="it" data-title="Statine" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target">Italiano</a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%A1%D7%98%D7%98%D7%99%D7%9F" title="סטטין – Hebrew" lang="he" hreflang="he" data-title="סטטין" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target">עברית</a></li><li class="interlanguage-link interwiki-ks mw-list-item"><a href="https://ks.wikipedia.org/wiki/%D8%B3%D9%B9%DB%8C%D9%B9%D9%86" title="سٹیٹن – Kashmiri" lang="ks" hreflang="ks" data-title="سٹیٹن" data-language-autonym="कॉशुर / کٲشُر" data-language-local-name="Kashmiri" class="interlanguage-link-target">कॉशुर / کٲشُر</a></li><li class="interlanguage-link interwiki-la mw-list-item"><a href="https://la.wikipedia.org/wiki/Statinum" title="Statinum – Latin" lang="la" hreflang="la" data-title="Statinum" data-language-autonym="Latina" data-language-local-name="Latin" class="interlanguage-link-target">Latina</a></li><li class="interlanguage-link interwiki-lt mw-list-item"><a href="https://lt.wikipedia.org/wiki/Statinai" title="Statinai – Lithuanian" lang="lt" hreflang="lt" data-title="Statinai" data-language-autonym="Lietuvių" data-language-local-name="Lithuanian" class="interlanguage-link-target">Lietuvių</a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Sztatin" title="Sztatin – Hungarian" lang="hu" hreflang="hu" data-title="Sztatin" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target">Magyar</a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%A1%D1%82%D0%B0%D1%82%D0%B8%D0%BD" title="Статин – Macedonian" lang="mk" hreflang="mk" data-title="Статин" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target">Македонски</a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Statin" title="Statin – Malay" lang="ms" hreflang="ms" data-title="Statin" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target">Bahasa Melayu</a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Statine" title="Statine – Dutch" lang="nl" hreflang="nl" data-title="Statine" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target">Nederlands</a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E3%82%B9%E3%82%BF%E3%83%81%E3%83%B3" title="スタチン – Japanese" lang="ja" hreflang="ja" data-title="スタチン" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target">日本語</a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Statiner" title="Statiner – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Statiner" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target">Norsk bokmål</a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%B7%E0%AD%8D%E0%AC%9F%E0%AC%BE%E0%AC%9F%E0%AC%BF%E0%AC%A8" title="ଷ୍ଟାଟିନ – Odia" lang="or" hreflang="or" data-title="ଷ୍ଟାଟିନ" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target">ଓଡ଼ିଆ</a></li><li class="interlanguage-link interwiki-pl badge-Q17437796 badge-featuredarticle mw-list-item" title="featured article badge"><a href="https://pl.wikipedia.org/wiki/Statyny" title="Statyny – Polish" lang="pl" hreflang="pl" data-title="Statyny" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target">Polski</a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Estatina" title="Estatina – Portuguese" lang="pt" hreflang="pt" data-title="Estatina" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target">Português</a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Statin%C4%83" title="Statină – Romanian" lang="ro" hreflang="ro" data-title="Statină" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target">Română</a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%A1%D1%82%D0%B0%D1%82%D0%B8%D0%BD%D1%8B" title="Статины – Russian" lang="ru" hreflang="ru" data-title="Статины" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target">Русский</a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Statin" title="Statin – Simple English" lang="en-simple" hreflang="en-simple" data-title="Statin" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target">Simple English</a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Statin" title="Statin – Slovenian" lang="sl" hreflang="sl" data-title="Statin" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target">Slovenščina</a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/Statin" title="Statin – Serbian" lang="sr" hreflang="sr" data-title="Statin" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target">Српски / srpski</a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Statin" title="Statin – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Statin" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target">Srpskohrvatski / српскохрватски</a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Statiinit" title="Statiinit – Finnish" lang="fi" hreflang="fi" data-title="Statiinit" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target">Suomi</a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Statin" title="Statin – Swedish" lang="sv" hreflang="sv" data-title="Statin" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target">Svenska</a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B8%AA%E0%B9%81%E0%B8%95%E0%B8%95%E0%B8%B4%E0%B8%99" title="สแตติน – Thai" lang="th" hreflang="th" data-title="สแตติน" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target">ไทย</a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Statinler" title="Statinler – Turkish" lang="tr" hreflang="tr" data-title="Statinler" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target">Türkçe</a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%A1%D1%82%D0%B0%D1%82%D0%B8%D0%BD%D0%B8" title="Статини – Ukrainian" lang="uk" hreflang="uk" data-title="Статини" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target">Українська</a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/Statin" title="Statin – Vietnamese" lang="vi" hreflang="vi" data-title="Statin" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" class="interlanguage-link-target">Tiếng Việt</a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E4%BB%96%E6%B1%80%E9%A1%9E%E8%97%A5%E7%89%A9" title="他汀類藥物 – Chinese" lang="zh" hreflang="zh" data-title="他汀類藥物" data-language-autonym="中文" data-language-local-name="Chinese" class="interlanguage-link-target">中文</a></li> </ul> <div class="after-portlet after-portlet-lang"><a href="https://www.wikidata.org/wiki/Special:EntityPage/Q954845#sitelinks-wikipedia" title="Edit interlanguage links" class="wbc-editpage">Edit links</a></div> </div> </div> </div> </header> <div class="vector-page-toolbar"> <div class="vector-page-toolbar-container"> <div id="left-navigation"> <nav aria-label="Namespaces"> <div id="p-associated-pages" class="vector-menu 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dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Class of drugs to lower cholesterol</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">This article is about cholesterol-lowering drugs. For the amino acid, see <a href="/wiki/Statine" title="Statine">statine</a>. For inhibiting hormones, see <a href="/wiki/Releasing_and_inhibiting_hormones" title="Releasing and inhibiting hormones">releasing and inhibiting hormones</a>.</div> <style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox"><tbody><tr><th colspan="2" class="infobox-above" style="background-color: #ddbbee">Statin</th></tr><tr><td colspan="2" class="infobox-subheader"><a href="/wiki/Drug_class" title="Drug class">Drug class</a></td></tr><tr><td colspan="2" class="infobox-image"><a href="/wiki/File:Lovastatin.svg" class="mw-file-description"><img alt="Lovastatin" src="//upload.wikimedia.org/wikipedia/commons/thumb/5/50/Lovastatin.svg/280px-Lovastatin.svg.png" decoding="async" width="280" height="241" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/50/Lovastatin.svg/420px-Lovastatin.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/50/Lovastatin.svg/560px-Lovastatin.svg.png 2x" data-file-width="512" data-file-height="440" /></a><div class="infobox-caption"><a href="/wiki/Lovastatin" title="Lovastatin">Lovastatin</a>, a compound isolated from <a href="/wiki/Aspergillus_terreus" title="Aspergillus terreus">Aspergillus terreus</a>, is the first statin to be marketed.</div></td></tr><tr><th colspan="2" class="infobox-header" style="background: #e8e8e8;">Class identifiers</th></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Synonym" title="Synonym">Synonyms</a></th><td class="infobox-data">HMG-CoA reductase inhibitors</td></tr><tr><th scope="row" class="infobox-label">Use</th><td class="infobox-data"><a href="/wiki/High_cholesterol" class="mw-redirect" title="High cholesterol">High cholesterol</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Anatomical_Therapeutic_Chemical_Classification_System" title="Anatomical Therapeutic Chemical Classification System">ATC code</a></th><td class="infobox-data"><a href="/wiki/ATC_code_C10AA" class="mw-redirect" title="ATC code C10AA">C10AA</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Biological_target" title="Biological target">Biological target</a></th><td class="infobox-data"><a href="/wiki/HMG-CoA_reductase" title="HMG-CoA reductase">HMG-CoA reductase</a></td></tr><tr><th colspan="2" class="infobox-header" style="background: #e8e8e8;">Clinical data</th></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Drugs.com" title="Drugs.com">Drugs.com</a></th><td class="infobox-data"><a rel="nofollow" class="external text" href="https://www.drugs.com/drug-class/hmg-coa-reductase-inhibitors.html">Drug Classes</a></td></tr><tr><th colspan="2" class="infobox-header" style="background: #e8e8e8;">External links</th></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></th><td class="infobox-data"><a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D019161">D019161</a></td></tr><tr><th colspan="2" class="infobox-header" style="background: #e8e8e8;">Legal status</th></tr><tr><td colspan="2" class="infobox-below" style="background: #e8e8e8; text-align: center"><a href="https://www.wikidata.org/wiki/Q954845" class="extiw" title="d:Q954845">In Wikidata</a></td></tr></tbody></table> Statins (or HMG-CoA reductase inhibitors) are a <a href="/wiki/Drug_class" title="Drug class">class</a> of medications that lower <a href="/wiki/Cholesterol" title="Cholesterol">cholesterol</a>. They are prescribed typically to people who are at high risk of <a href="/wiki/Cardiovascular_disease" title="Cardiovascular disease">cardiovascular disease</a>.<a href="#cite_note-Cardiovascular_Media-1">[1]</a> <a href="/wiki/Low-density_lipoprotein" title="Low-density lipoprotein">Low-density lipoprotein</a> (LDL) carriers of <a href="/wiki/Cholesterol" title="Cholesterol">cholesterol</a> play a key role in the development of <a href="/wiki/Atherosclerosis" title="Atherosclerosis">atherosclerosis</a> and <a href="/wiki/Coronary_heart_disease" class="mw-redirect" title="Coronary heart disease">coronary heart disease</a> via the mechanisms described by the <a href="/wiki/Lipid_hypothesis" title="Lipid hypothesis">lipid hypothesis</a>. As <a href="/wiki/Lipid-lowering_medication" class="mw-redirect" title="Lipid-lowering medication">lipid-lowering medications</a>, statins are effective in lowering LDL cholesterol; they are widely used for <a href="/wiki/Primary_prevention" class="mw-redirect" title="Primary prevention">primary prevention</a> in people at high risk of cardiovascular disease, as well as in <a href="/wiki/Secondary_prevention" class="mw-redirect" title="Secondary prevention">secondary prevention</a> for those who have developed cardiovascular disease.<a href="#cite_note-AlenghatDavis2019-2">[2]</a><a href="#cite_note-3">[3]</a><a href="#cite_note-Cochrane13-4">[4]</a> Side effects of statins include <a href="/wiki/Muscle_pain" class="mw-redirect" title="Muscle pain">muscle pain</a>, increased risk of <a href="/wiki/Diabetes" title="Diabetes">diabetes</a>, and abnormal blood levels of certain <a href="/wiki/Liver_enzymes" class="mw-redirect" title="Liver enzymes">liver enzymes</a>.<a href="#cite_note-Naci2013-5">[5]</a> Additionally, they have rare but severe adverse effects, particularly muscle damage, and very rarely <a href="/wiki/Rhabdomyolysis" title="Rhabdomyolysis">rhabdomyolysis</a>.<a href="#cite_note-Jacob2011-6">[6]</a><a href="#cite_note-7">[7]</a> They act by inhibiting the enzyme <a href="/wiki/HMG-CoA_reductase" title="HMG-CoA reductase">HMG-CoA reductase</a>, which plays a central role in the production of cholesterol. High cholesterol levels have been associated with cardiovascular disease.<a href="#cite_note-8">[8]</a> There are <a href="#Available_forms">various forms</a> of statins, some of which include <a href="/wiki/Atorvastatin" title="Atorvastatin">atorvastatin</a>, <a href="/wiki/Fluvastatin" title="Fluvastatin">fluvastatin</a>, <a href="/wiki/Lovastatin" title="Lovastatin">lovastatin</a>, <a href="/wiki/Pitavastatin" title="Pitavastatin">pitavastatin</a>, <a href="/wiki/Pravastatin" title="Pravastatin">pravastatin</a>, <a href="/wiki/Rosuvastatin" title="Rosuvastatin">rosuvastatin</a>, and <a href="/wiki/Simvastatin" title="Simvastatin">simvastatin</a>.<a href="#cite_note-Martindale-9">[9]</a> Combination preparations of a statin and another agent, such as <a href="/wiki/Ezetimibe/simvastatin" title="Ezetimibe/simvastatin">ezetimibe/simvastatin</a>, are also available. The class is on the <a href="/wiki/World_Health_Organization%27s_List_of_Essential_Medicines" class="mw-redirect" title="World Health Organization's List of Essential Medicines">World Health Organization's List of Essential Medicines</a> with simvastatin being the listed medicine.<a href="#cite_note-WHO21st-10">[10]</a> In 2005, sales were estimated at US$18.7 billion in the United States.<a href="#cite_note-Taylor2013-11">[11]</a> The best-selling statin is atorvastatin, also known as Lipitor, which in 2003 became the best-selling pharmaceutical in history.<a href="#cite_note-Simons-12">[12]</a> The manufacturer <a href="/wiki/Pfizer" title="Pfizer">Pfizer</a> reported sales of US$12.4 billion in 2008.<a href="#cite_note-13">[13]</a> Patient compliance with statin usage is problematic despite robust evidence of the benefits.<a href="#cite_note-14">[14]</a><a href="#cite_note-15">[15]</a> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Medical_uses">Medical uses</h2>[<a href="/w/index.php?title=Statin&action=edit&section=1" title="Edit section: Medical uses">edit</a>]</div> Statins are usually used to lower blood cholesterol levels and reduce risk for illnesses related to atherosclerosis, with a varying degree of effect depending on underlying <a href="/wiki/Framingham_Risk_Score" title="Framingham Risk Score">risk factors</a> and history of cardiovascular disease.<a href="#cite_note-:4-16">[16]</a> A 2022 systematic review found the <a href="/wiki/Absolute_risk" title="Absolute risk">absolute risk</a> reductions for three hard outcomes – all-cause mortality, myocardial infarction, and stroke – to be 0.8%, 1.3%, and 0.4%, respectively (relative risk: 9%, 29%, 14%). The association between effect size and LDL cholesterol reduction was unclear, and there was significant clinical and statistical <a href="/wiki/Study_heterogeneity" title="Study heterogeneity">heterogeneity</a> between trials.<a href="#cite_note-17">[17]</a> <a href="/wiki/Clinical_practice_guidelines" class="mw-redirect" title="Clinical practice guidelines">Clinical practice guidelines</a> generally recommend that people at low risk start with lifestyle modification through a cholesterol-lowering diet and <a href="/wiki/Physical_exercise" class="mw-redirect" title="Physical exercise">physical exercise</a>; for those unable to meet their lipid-lowering goals through such methods, statins can be helpful.<a href="#cite_note-ATPIII-18">[18]</a><a href="#cite_note-NICE-19">[19]</a> The medication appears to work equally well regardless of sex,<a href="#cite_note-20">[20]</a> although some sex-related differences in treatment response were described.<a href="#cite_note-21">[21]</a> If there is an underlying history of cardiovascular disease, it has a significant impact on the effects of statin. This can be used to divide medication usage into broad categories of primary and secondary prevention.<a href="#cite_note-AHA_2018-22">[22]</a> <div class="mw-heading mw-heading3"><h3 id="Primary_prevention">Primary prevention</h3>[<a href="/w/index.php?title=Statin&action=edit&section=2" title="Edit section: Primary prevention">edit</a>]</div> For the primary prevention of cardiovascular disease, the <a href="/wiki/United_States_Preventive_Services_Task_Force" title="United States Preventive Services Task Force">United States Preventive Services Task Force</a> (USPSTF) 2016 guidelines recommend statins for those who have at least one risk factor for <a href="/wiki/Coronary_heart_disease" class="mw-redirect" title="Coronary heart disease">coronary heart disease</a>, are between 40 and 75 years old, and have at least a 10% 10-year risk of heart disease, as calculated by the 2013 ACC/AHA Pooled Cohort algorithm.<a href="#cite_note-AHA_2018-22">[22]</a><a href="#cite_note-JAMA2016-23">[23]</a><a href="#cite_note-24">[24]</a> Risk factors for coronary heart disease included <a href="/wiki/Dyslipidemia" title="Dyslipidemia">abnormal lipid levels in the blood</a>, <a href="/wiki/Diabetes_mellitus" class="mw-redirect" title="Diabetes mellitus">diabetes mellitus</a>, <a href="/wiki/High_blood_pressure" class="mw-redirect" title="High blood pressure">high blood pressure</a>, and <a href="/wiki/Smoking" title="Smoking">smoking</a>.<a href="#cite_note-JAMA2016-23">[23]</a> They recommended selective use of low-to-moderate doses statins in the same adults who have a calculated 10-year cardiovascular disease event risk of 7.5–10% or greater.<a href="#cite_note-JAMA2016-23">[23]</a> In people over the age of 70, statins decrease the risk of cardiovascular disease but only in those with a history of heavy cholesterol blockage in their arteries.<a href="#cite_note-25">[25]</a> Most evidence suggests that statins are also effective in preventing heart disease in those with <a href="/wiki/Hypercholesterolemia" title="Hypercholesterolemia">high cholesterol</a> but no history of heart disease. A 2013 <a href="/wiki/Cochrane_review" class="mw-redirect" title="Cochrane review">Cochrane review</a> found a decrease in risk of death and other poor outcomes without any evidence of harm.<a href="#cite_note-Cochrane13-4">[4]</a> For every 138 people treated for 5 years, one fewer dies; for every 49 treated, one fewer has an episode of heart disease.<a href="#cite_note-Taylor2013-11">[11]</a> A 2011 review reached similar conclusions,<a href="#cite_note-CMAJ11-26">[26]</a> and a 2012 review found benefits in both women and men.<a href="#cite_note-27">[27]</a> A 2010 review concluded that treatment without history of cardiovascular disease reduces cardiovascular events in men but not women, and provides no mortality benefit in either sex.<a href="#cite_note-28">[28]</a> Two other meta-analyses published that year, one of which used data obtained exclusively from women, found no mortality benefit in primary prevention.<a href="#cite_note-29">[29]</a><a href="#cite_note-30">[30]</a> The <a href="/wiki/National_Institute_for_Health_and_Clinical_Excellence" class="mw-redirect" title="National Institute for Health and Clinical Excellence">National Institute for Health and Clinical Excellence</a> (NICE) recommends statin treatment for adults with an estimated 10 year risk of developing cardiovascular disease that is greater than 10%.<a href="#cite_note-31">[31]</a> Guidelines by the <a href="/wiki/American_College_of_Cardiology" title="American College of Cardiology">American College of Cardiology</a> and the <a href="/wiki/American_Heart_Association" title="American Heart Association">American Heart Association</a> recommend statin treatment for primary prevention of cardiovascular disease in adults with LDL cholesterol ≥ 190 mg/dL (4.9 mmol/L) or those with diabetes, age 40–75 with LDL-C 70–190 mg/dL (1.8–4.9 mmol/dL); or in those with a 10-year risk of developing heart attack or stroke of 7.5% or more. In this latter group, statin assignment was not automatic, but was recommended to occur only after a clinician-patient risk discussion with shared decision making where other risk factors and lifestyle are addressed, the potential for benefit from a statin is weighed against the potential for adverse effects or drug interactions and informed patient preference is elicited. Moreover, if a risk decision was uncertain, factors such as family history, coronary calcium score, <a href="/wiki/Ankle-brachial_pressure_index" class="mw-redirect" title="Ankle-brachial pressure index">ankle-brachial index</a>, and an inflammation test (<a href="/wiki/C-reactive_protein" title="C-reactive protein">hs-CRP</a> ≥ 2.0 mg/L) were suggested to inform the risk decision. Additional factors that could be used were an LDL-C ≥ 160 mg/dL (4.14 mmol/L) or a very high lifetime risk.<a href="#cite_note-32">[32]</a> However, critics such as Steven E. Nissen say that the AHA/ACC guidelines were not properly validated, overestimate the risk by at least 50%, and recommend statins for people who will not benefit, based on populations whose observed risk is lower than predicted by the guidelines.<a href="#cite_note-Nissen2014-33">[33]</a> The <a href="/wiki/European_Society_of_Cardiology" title="European Society of Cardiology">European Society of Cardiology</a> and the European Atherosclerosis Society recommend the use of statins for primary prevention, depending on baseline estimated cardiovascular score and LDL thresholds.<a href="#cite_note-34">[34]</a> <div class="mw-heading mw-heading3"><h3 id="Secondary_prevention">Secondary prevention</h3>[<a href="/w/index.php?title=Statin&action=edit&section=3" title="Edit section: Secondary prevention">edit</a>]</div> Statins are effective in decreasing mortality in people with pre-existing <a href="/wiki/Cardiovascular_disease" title="Cardiovascular disease">cardiovascular disease</a>.<a href="#cite_note-Collins2016-35">[35]</a> Pre-existing disease can have many manifestations. Defining illnesses include a prior heart attack, stroke, stable or unstable <a href="/wiki/Angina" title="Angina">angina</a>, <a href="/wiki/Aortic_aneurysm" title="Aortic aneurysm">aortic aneurysm</a>, or other arterial <a href="/wiki/Ischemic" class="mw-redirect" title="Ischemic">ischemic</a> disease, in the presence of atherosclerosis.<a href="#cite_note-AHA_2018-22">[22]</a> They are also advocated for use in people at high risk of developing coronary heart disease.<a href="#cite_note-NICEquick-36">[36]</a> On average, statins can lower <a href="/wiki/LDL_cholesterol" class="mw-redirect" title="LDL cholesterol">LDL cholesterol</a> by 1.8 mmol/L (70 mg/dL), which translates into an estimated 60% decrease in the number of cardiac events (heart attack, <a href="/wiki/Sudden_cardiac_death" class="mw-redirect" title="Sudden cardiac death">sudden cardiac death</a>) and a 17% reduced risk of <a href="/wiki/Stroke" title="Stroke">stroke</a> after long-term treatment.<a href="#cite_note-37">[37]</a> A greater benefit is observed with high-intensity statin therapy.<a href="#cite_note-38">[38]</a> They have less effect than the <a href="/wiki/Fibrate" title="Fibrate">fibrates</a> or <a href="/wiki/Niacin_(substance)" class="mw-redirect" title="Niacin (substance)">niacin</a> in reducing <a href="/wiki/Triglyceride" title="Triglyceride">triglycerides</a> and raising <a href="/wiki/HDL-cholesterol" class="mw-redirect" title="HDL-cholesterol">HDL-cholesterol</a> ("good cholesterol").<a href="#cite_note-Kushner2016-39">[39]</a><a href="#cite_note-Khera2013-40">[40]</a> No studies have examined the effect of statins on cognition in patients with prior stroke. However, two large studies (HPS and PROSPER) that included people with vascular diseases reported that simvastatin and pravastatin did not impact cognition.<a href="#cite_note-41">[41]</a> Statins have been studied for improving operative outcomes in cardiac and vascular surgery.<a href="#cite_note-42">[42]</a> Mortality and adverse cardiovascular events were reduced in statin groups.<a href="#cite_note-43">[43]</a> Older adults who receive statin therapy at time of discharge from the hospital after an <a href="/wiki/Inpatient" class="mw-redirect" title="Inpatient">inpatient</a> stay have been studied. People with cardiac ischemia not previously on statins at the time of admission have a lower risk of major cardiac adverse events and hospital readmission two years post-hospitalization.<a href="#cite_note-44">[44]</a><a href="#cite_note-45">[45]</a> <div class="mw-heading mw-heading3"><h3 id="Statin_product_offerings_-_comparative_effectiveness">Statin product offerings - comparative effectiveness</h3>[<a href="/w/index.php?title=Statin&action=edit&section=4" title="Edit section: Statin product offerings - comparative effectiveness">edit</a>]</div> All statins appear effective regardless of potency or degree of cholesterol reduction.<a href="#cite_note-CMAJ11-26">[26]</a><a href="#cite_note-46">[46]</a><a href="#cite_note-47">[47]</a> Simvastatin and pravastatin appear to have a reduced incidence of side-effects.<a href="#cite_note-Naci2013-5">[5]</a><a href="#cite_note-48">[48]</a><a href="#cite_note-49">[49]</a> <div class="mw-heading mw-heading3"><h3 id="Women_and_children">Women and children</h3>[<a href="/w/index.php?title=Statin&action=edit&section=5" title="Edit section: Women and children">edit</a>]</div> According to the 2015 Cochrane systematic review, atorvastatin showed greater cholesterol-lowering effect in women than in men compared to rosuvastatin.<a href="#cite_note-AdamsTsangWright2015-50">[50]</a> In children, statins are effective at reducing cholesterol levels in those with <a href="/wiki/Familial_hypercholesterolemia" title="Familial hypercholesterolemia">familial hypercholesterolemia</a>.<a href="#cite_note-:0-51">[51]</a> Their long term safety is, however, unclear.<a href="#cite_note-:0-51">[51]</a><a href="#cite_note-52">[52]</a> Some recommend that if lifestyle changes are not enough statins should be started at 8 years old.<a href="#cite_note-53">[53]</a> <div class="mw-heading mw-heading3"><h3 id="Familial_hypercholesterolemia">Familial hypercholesterolemia</h3>[<a href="/w/index.php?title=Statin&action=edit&section=6" title="Edit section: Familial hypercholesterolemia">edit</a>]</div> Statins may be less effective in reducing LDL cholesterol in people with familial hypercholesterolemia, especially those with <a href="/wiki/Homozygous" class="mw-redirect" title="Homozygous">homozygous</a> deficiencies.<a href="#cite_note-Repas2014-54">[54]</a> These people have defects usually in either the <a href="/wiki/LDL_receptor" title="LDL receptor">LDL receptor</a> or <a href="/wiki/Apolipoprotein_B" title="Apolipoprotein B">apolipoprotein B</a> genes, both of which are responsible for LDL clearance from the blood.<a href="#cite_note-55">[55]</a> Statins remain a first-line treatment in familial hypercholesterolemia,<a href="#cite_note-Repas2014-54">[54]</a> although other cholesterol-reducing measures may be required.<a href="#cite_note-Rader2003-56">[56]</a> In people with homozygous deficiencies, statins may still prove helpful, albeit at high doses and in combination with other cholesterol-reducing medications.<a href="#cite_note-57">[57]</a> <div class="mw-heading mw-heading3"><h3 id="Contrast-induced_nephropathy">Contrast-induced nephropathy</h3>[<a href="/w/index.php?title=Statin&action=edit&section=7" title="Edit section: Contrast-induced nephropathy">edit</a>]</div> A 2014 <a href="/wiki/Meta-analysis" title="Meta-analysis">meta-analysis</a> found that statins could reduce the risk of <a href="/wiki/Contrast-induced_nephropathy" title="Contrast-induced nephropathy">contrast-induced nephropathy</a> by 53% in people undergoing <a href="/wiki/Coronary_catheterization" title="Coronary catheterization">coronary angiography</a>/percutaneous interventions. The effect was found to be stronger among those with preexisting kidney dysfunction or diabetes mellitus.<a href="#cite_note-58">[58]</a> <div class="mw-heading mw-heading3"><h3 id="Chronic_kidney_disease">Chronic kidney disease</h3>[<a href="/w/index.php?title=Statin&action=edit&section=8" title="Edit section: Chronic kidney disease">edit</a>]</div> The risk of cardiovascular disease is similar in people with chronic kidney disease and coronary artery disease and statins are often suggested.<a href="#cite_note-:4-16">[16]</a> There is some evidence that appropriate use of statin medications in people with chronic kidney disease who do not require dialysis may reduce mortality and the incidence of major cardiac events by up to 20% and are not that likely to increase the risk of stroke or kidney failure.<a href="#cite_note-:4-16">[16]</a> <big>Asthma</big> Statins have been identified as having a possible adjunct role in the treatment of asthma through anti-inflammatory pathways.<a href="#cite_note-:3-59">[59]</a> There is low quality evidence for the use of statins in treating asthma, however further research is required to determine the effectiveness and safety of this therapy in those with asthma.<a href="#cite_note-:3-59">[59]</a> <div class="mw-heading mw-heading2"><h2 id="Adverse_effects">Adverse effects</h2>[<a href="/w/index.php?title=Statin&action=edit&section=9" title="Edit section: Adverse effects">edit</a>]</div> <table class="wikitable" style="float: right"> <caption>Choosing a statin for people with special considerations<a href="#cite_note-BBDstatins2-60">[60]</a> </caption> <tbody><tr> <th>Condition </th> <th>Commonly recommended statins </th> <th>Explanation </th></tr> <tr> <td><a href="/wiki/Kidney_transplantation" title="Kidney transplantation">Kidney transplantation</a> recipients taking <a href="/wiki/Ciclosporin" title="Ciclosporin">ciclosporin</a> </td> <td><a href="/wiki/Pravastatin" title="Pravastatin">Pravastatin</a> or <a href="/wiki/Fluvastatin" title="Fluvastatin">fluvastatin</a> </td> <td>Drug interactions are possible, but studies have not shown that these statins increase exposure to ciclosporin.<a href="#cite_note-61">[61]</a> </td></tr> <tr> <td><a href="/wiki/HIV-positive_people" title="HIV-positive people">HIV-positive people</a> taking <a href="/wiki/Protease_inhibitor_(pharmacology)" title="Protease inhibitor (pharmacology)">protease inhibitors</a> </td> <td><a href="/wiki/Atorvastatin" title="Atorvastatin">Atorvastatin</a>, <a href="/wiki/Pravastatin" title="Pravastatin">pravastatin</a> or <a href="/wiki/Fluvastatin" title="Fluvastatin">fluvastatin</a> </td> <td>Negative interactions are more likely with other choices.<a href="#cite_note-62">[62]</a> </td></tr> <tr> <td>Persons taking <a href="/wiki/Gemfibrozil" title="Gemfibrozil">gemfibrozil</a>, a non-statin lipid-lowering drug </td> <td>Atorvastatin </td> <td>Combining gemfibrozil and a statin increases risk of <a href="/wiki/Rhabdomyolysis" title="Rhabdomyolysis">rhabdomyolysis</a> and subsequently <a href="/wiki/Kidney_failure" title="Kidney failure">kidney failure</a><a href="#cite_note-safety-63">[63]</a><a href="#cite_note-64">[64]</a> </td></tr> <tr> <td>Persons taking the <a href="/wiki/Anticoagulant" title="Anticoagulant">anticoagulant</a> <a href="/wiki/Warfarin" title="Warfarin">warfarin</a> </td> <td>Any statin </td> <td>The statin use may require that the warfarin dose be changed, as some statins increase the effect of warfarin.<a href="#cite_note-65">[65]</a> </td></tr></tbody></table> The most important adverse side effects are muscle problems, an increased risk of <a href="/wiki/Diabetes_mellitus" class="mw-redirect" title="Diabetes mellitus">diabetes mellitus</a>, and <a href="/wiki/Elevated_transaminases" title="Elevated transaminases">increased liver enzymes in the blood</a> due to <a href="/wiki/Liver_damage" class="mw-redirect" title="Liver damage">liver damage</a>.<a href="#cite_note-Naci2013-5">[5]</a><a href="#cite_note-Bellosta2012-66">[66]</a> Over 5 years of treatment statins result in 75 cases of diabetes, 7.5 cases of <a href="/wiki/Bleeding_stroke" class="mw-redirect" title="Bleeding stroke">bleeding stroke</a>, and 5 cases of muscle damage per 10,000 people treated.<a href="#cite_note-Collins2016-35">[35]</a> This could be due to the statins inhibiting the enzyme (HMG-CoA reductase), which is necessary to make cholesterol, but also for other processes, such as <a href="/wiki/Coenzyme_Q10" title="Coenzyme Q10">CoQ10</a> production, which is important for muscle function and sugar regulation.<a href="#cite_note-67">[67]</a> Other possible adverse effects include <a href="/wiki/Neuropathy" class="mw-redirect" title="Neuropathy">neuropathy</a>,<a href="#cite_note-68">[68]</a><a href="#cite_note-69">[69]</a> <a href="/wiki/Pancreas" title="Pancreas">pancreatic</a> and <a href="/wiki/Liver" title="Liver">liver</a> dysfunction, and <a href="/wiki/Sexual_dysfunction" title="Sexual dysfunction">sexual dysfunction</a>.<a href="#cite_note-GolombEvans2008-70">[70]</a> The rate at which such events occur has been widely debated, in part because the risk/benefit ratio of statins in low-risk populations is highly dependent on the rate of adverse events.<a href="#cite_note-71">[71]</a><a href="#cite_note-72">[72]</a><a href="#cite_note-73">[73]</a> A <a href="/wiki/Cochrane_Library" title="Cochrane Library">Cochrane</a> meta-analysis of statin clinical trials in primary prevention found no evidence of excess adverse events among those treated with statins compared to placebo.<a href="#cite_note-Cochrane13-4">[4]</a> Another meta-analysis found a 39% increase in adverse events in statin treated people relative to those receiving placebo, but no increase in serious adverse events.<a href="#cite_note-74">[74]</a> The author of one study argued that adverse events are more common in clinical practice than in <a href="/wiki/Randomized_clinical_trial" class="mw-redirect" title="Randomized clinical trial">randomized clinical trials</a>.<a href="#cite_note-GolombEvans2008-70">[70]</a> A systematic review concluded that while clinical trial meta-analyses underestimate the rate of muscle pain associated with statin use, the rates of <a href="/wiki/Rhabdomyolysis" title="Rhabdomyolysis">rhabdomyolysis</a> are still "reassuringly low" and similar to those seen in clinical trials (about 1–2 per 10,000 person years).<a href="#cite_note-Mancini_GB,_Baker_S,_Bergeron_J,_et_al._2011_635–62-75">[75]</a> Another systematic review from the International Centre for Circulatory Health of the <a href="/wiki/National_Heart_and_Lung_Institute" class="mw-redirect" title="National Heart and Lung Institute">National Heart and Lung Institute</a> in <a href="/wiki/London" title="London">London</a> concluded that only a small fraction of side effects reported by people on statins are actually attributable to the statin.<a href="#cite_note-76">[76]</a> <div class="mw-heading mw-heading3"><h3 id="Cognitive_effects">Cognitive effects</h3>[<a href="/w/index.php?title=Statin&action=edit&section=10" title="Edit section: Cognitive effects">edit</a>]</div> Multiple systematic reviews and meta-analyses have concluded that the available evidence does not support an association between statin use and cognitive decline.<a href="#cite_note-Swiger2013-77">[77]</a><a href="#cite_note-78">[78]</a><a href="#cite_note-Richardson-79">[79]</a><a href="#cite_note-Smith2014-80">[80]</a><a href="#cite_note-Bitzur2016-81">[81]</a> A 2010 meta-review of medical trials involving over 65,000 people concluded that Statins decreased the risk of dementia, Alzheimer's disease, and even improved cognitive impairment in some cases.<a href="#cite_note-82">[82]</a>[<a href="/wiki/Wikipedia:Manual_of_Style/Dates_and_numbers#Chronological_items" title="Wikipedia:Manual of Style/Dates and numbers">needs update</a>] Additionally, both the Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) study<a href="#cite_note-83">[83]</a> and the Health Protection Study (HPS) demonstrated that simvastatin and pravastatin did not affect cognition for patients with risk factors for, or a history of, vascular diseases.<a href="#cite_note-84">[84]</a> There are reports of reversible cognitive impairment with statins.<a href="#cite_note-McDonagh-85">[85]</a> The U.S. <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">Food and Drug Administration</a> (FDA) package insert on statins includes a warning about the potential for non-serious and reversible cognitive side effects with the medication (memory loss, confusion).<a href="#cite_note-86">[86]</a> <div class="mw-heading mw-heading3"><h3 id="Muscles">Muscles</h3>[<a href="/w/index.php?title=Statin&action=edit&section=11" title="Edit section: Muscles">edit</a>]</div> In observational studies 10–15% of people who take statins experience <a href="/wiki/Skeletal_striated_muscle" class="mw-redirect" title="Skeletal striated muscle">muscle</a> problems; in most cases these consist of <a href="/wiki/Myalgia" title="Myalgia">muscle pain</a>.<a href="#cite_note-Jacob2011-6">[6]</a> These rates, which are much higher than those seen in randomized clinical trials<a href="#cite_note-Mancini_GB,_Baker_S,_Bergeron_J,_et_al._2011_635–62-75">[75]</a> have been the topic of extensive debate and discussion.<a href="#cite_note-Collins2016-35">[35]</a><a href="#cite_note-Backes2017-87">[87]</a> Muscle pain and other symptoms often cause patients to stop taking a statin.<a href="#cite_note-88">[88]</a> This is known as statin intolerance. A 2021 double-blind <a href="/wiki/N_of_1_trial" title="N of 1 trial">multiple crossover</a> <a href="/wiki/Randomized_controlled_trial" title="Randomized controlled trial">randomized controlled trial</a> (RCT) in statin-intolerant patients found that adverse effects, including muscle pain, were similar between atorvastatin and placebo.<a href="#cite_note-89">[89]</a> A smaller double-blind RCT obtained similar results.<a href="#cite_note-90">[90]</a> The results of these studies help explain why statin symptom rates in observational studies are so much higher than in double-blind RCTs and support the notion that the difference results from the <a href="/wiki/Nocebo" title="Nocebo">nocebo effect</a>; that the symptoms are caused by expectations of harm.<a href="#cite_note-91">[91]</a> Media reporting on statins is often negative, and patient leaflets inform patients that rare but potentially serious muscle problems can occur during statin treatment. These create expectations of harm. Nocebo symptoms are real and bothersome and are a major barrier to treatment. Because of this, many people stop taking statins,<a href="#cite_note-92">[92]</a> which have been proven in numerous large-scale RCTs to reduce heart attacks, stroke, and deaths<a href="#cite_note-93">[93]</a> – as long as people continue to take them. Serious muscle problems such as <a href="/wiki/Rhabdomyolysis" title="Rhabdomyolysis">rhabdomyolysis</a> (destruction of muscle cells) and <a href="/wiki/Statin-associated_autoimmune_myopathy" title="Statin-associated autoimmune myopathy">statin-associated autoimmune myopathy</a> occur in less than 0.1% of treated people.<a href="#cite_note-94">[94]</a> Rhabdomyolysis can in turn result in life-threatening <a href="/wiki/Acute_tubular_necrosis" title="Acute tubular necrosis">kidney injury</a>. The risk of statin-induced rhabdomyolysis increases with older age, use of interacting medications such as <a href="/wiki/Fibrates" class="mw-redirect" title="Fibrates">fibrates</a>, and <a href="/wiki/Hypothyroidism" title="Hypothyroidism">hypothyroidism</a>.<a href="#cite_note-95">[95]</a><a href="#cite_note-96">[96]</a> <a href="/wiki/Coenzyme_Q10" title="Coenzyme Q10">Coenzyme Q10</a> (ubiquinone) levels are decreased in statin use;<a href="#cite_note-Potgieter2013-97">[97]</a> CoQ10 supplements are sometimes used to treat statin-associated myopathy, though evidence of their efficacy is lacking as of 2017<a class="external text" href="https://en.wikipedia.org/w/index.php?title=Statin&action=edit">[update]</a>.<a href="#cite_note-Tan2017-98">[98]</a> The gene <a href="/wiki/SLCO1B1" class="mw-redirect" title="SLCO1B1">SLCO1B1</a> (Solute carrier organic anion transporter family member 1B1) codes for an <a href="/wiki/Organic_anion-transporting_polypeptide" class="mw-redirect" title="Organic anion-transporting polypeptide">organic anion-transporting polypeptide</a> that is involved in the regulation of the absorption of statins. A common variation in this gene was found in 2008 to significantly increase the risk of myopathy.<a href="#cite_note-The_SEARCH_Collaborative_Group-99">[99]</a> Records exist of over 250,000 people treated from 1998 to 2001 with the statin drugs atorvastatin, cerivastatin, fluvastatin, lovastatin, pravastatin, and simvastatin.<a href="#cite_note-Graham2004-100">[100]</a> The incidence of rhabdomyolysis was 0.44 per 10,000 patients treated with statins other than cerivastatin. However, the risk was over 10-fold greater if cerivastatin was used, or if the standard statins (atorvastatin, fluvastatin, lovastatin, pravastatin, or simvastatin) were combined with a <a href="/wiki/Fibrate" title="Fibrate">fibrate</a> (<a href="/wiki/Fenofibrate" title="Fenofibrate">fenofibrate</a> or <a href="/wiki/Gemfibrozil" title="Gemfibrozil">gemfibrozil</a>) treatment. Cerivastatin was withdrawn by its manufacturer in 2001.<a href="#cite_note-Backman2016-101">[101]</a> Some researchers have suggested hydrophilic statins, such as fluvastatin, rosuvastatin, and pravastatin, are less toxic than lipophilic statins, such as atorvastatin, lovastatin, and simvastatin, but other studies have not found a connection.<a href="#cite_note-Hanaietal2007-102">[102]</a> <a href="/wiki/Lovastatin" title="Lovastatin">Lovastatin</a> induces the expression of gene <a href="/wiki/FBXO32" title="FBXO32">atrogin-1</a>, which is believed to be responsible in promoting muscle fiber damage.<a href="#cite_note-Hanaietal2007-102">[102]</a> Tendon rupture does not appear to occur.<a href="#cite_note-103">[103]</a> <div class="mw-heading mw-heading3"><h3 id="Diabetes">Diabetes</h3>[<a href="/w/index.php?title=Statin&action=edit&section=12" title="Edit section: Diabetes">edit</a>]</div> The relationship between statin use and risk of developing <a href="/wiki/Diabetes_mellitus" class="mw-redirect" title="Diabetes mellitus">diabetes</a> remains unclear and the results of reviews are mixed.<a href="#cite_note-pmid20167359-104">[104]</a><a href="#cite_note-Chou2016-105">[105]</a><a href="#cite_note-Rochlani2017-106">[106]</a><a href="#cite_note-107">[107]</a> Higher doses have a greater effect, but the decrease in cardiovascular disease outweighs the risk of developing diabetes.<a href="#cite_note-pmid21693744-108">[108]</a> Use in postmenopausal women is associated with an increased risk for diabetes.<a href="#cite_note-Culver_2012-109">[109]</a> The exact mechanism responsible for the possible increased risk of diabetes mellitus associated with statin use is unclear.<a href="#cite_note-Rochlani2017-106">[106]</a> However, recent findings have indicated the inhibition of <a href="/wiki/HMG-CoA_reductase" title="HMG-CoA reductase">HMGCoAR</a> as a key mechanism.<a href="#cite_note-110">[110]</a> Statins are thought to decrease cells' uptake of glucose from the bloodstream in response to the <a href="/wiki/Hormone" title="Hormone">hormone</a> <a href="/wiki/Insulin" title="Insulin">insulin</a>.<a href="#cite_note-Rochlani2017-106">[106]</a> One way this is thought to occur is by interfering with cholesterol synthesis which is necessary for the production of certain proteins responsible for glucose uptake into cells such as <a href="/wiki/GLUT1" title="GLUT1">GLUT1</a>.<a href="#cite_note-Rochlani2017-106">[106]</a> <div class="mw-heading mw-heading3"><h3 id="Cancer">Cancer</h3>[<a href="/w/index.php?title=Statin&action=edit&section=13" title="Edit section: Cancer">edit</a>]</div> Several meta-analyses have found no increased risk of cancer, and some meta-analyses have found a reduced risk.<a href="#cite_note-111">[111]</a><a href="#cite_note-112">[112]</a><a href="#cite_note-113">[113]</a><a href="#cite_note-Dale2006-114">[114]</a><a href="#cite_note-115">[115]</a> Specifically, statins may reduce the risk of <a href="/wiki/Esophageal_cancer" title="Esophageal cancer">esophageal cancer</a>,<a href="#cite_note-116">[116]</a> <a href="/wiki/Colorectal_cancer" title="Colorectal cancer">colorectal cancer</a>,<a href="#cite_note-117">[117]</a> <a href="/wiki/Gastric_cancer" class="mw-redirect" title="Gastric cancer">gastric cancer</a>,<a href="#cite_note-118">[118]</a><a href="#cite_note-119">[119]</a> <a href="/wiki/Hepatocellular_carcinoma" title="Hepatocellular carcinoma">hepatocellular carcinoma</a>,<a href="#cite_note-120">[120]</a> and possibly <a href="/wiki/Prostate_cancer" title="Prostate cancer">prostate cancer</a>.<a href="#cite_note-121">[121]</a><a href="#cite_note-122">[122]</a> They appear to have no effect on the risk of <a href="/wiki/Lung_cancer" title="Lung cancer">lung cancer</a>,<a href="#cite_note-123">[123]</a> <a href="/wiki/Kidney_cancer" title="Kidney cancer">kidney cancer</a>,<a href="#cite_note-124">[124]</a> <a href="/wiki/Breast_cancer" title="Breast cancer">breast cancer</a>,<a href="#cite_note-125">[125]</a> <a href="/wiki/Pancreatic_cancer" title="Pancreatic cancer">pancreatic cancer</a>,<a href="#cite_note-126">[126]</a> or <a href="/wiki/Bladder_cancer" title="Bladder cancer">bladder cancer</a>.<a href="#cite_note-127">[127]</a> <div class="mw-heading mw-heading3"><h3 id="Drug_interactions">Drug interactions</h3>[<a href="/w/index.php?title=Statin&action=edit&section=14" title="Edit section: Drug interactions">edit</a>]</div> Combining any statin with a <a href="/wiki/Fibrate" title="Fibrate">fibrate</a> or <a href="/wiki/Niacin_(substance)" class="mw-redirect" title="Niacin (substance)">niacin</a> (other categories of lipid-lowering drugs) increases the risks for <a href="/wiki/Rhabdomyolysis" title="Rhabdomyolysis">rhabdomyolysis</a> to almost 6.0 per 10,000 person-years.<a href="#cite_note-Graham2004-100">[100]</a> Monitoring liver enzymes and creatine kinase is especially prudent in those on high-dose statins or in those on statin/fibrate combinations, and mandatory in the case of muscle cramps or of deterioration in <a href="/wiki/Kidney_function" class="mw-redirect" title="Kidney function">kidney function</a>.<a href="#cite_note-128">[128]</a> Consumption of <a href="/wiki/Grapefruit" title="Grapefruit">grapefruit</a> or <a href="/wiki/Grapefruit_juice" title="Grapefruit juice">grapefruit juice</a> <a href="/wiki/Grapefruit%E2%80%93drug_interactions" title="Grapefruit–drug interactions">inhibits</a> the metabolism of certain statins, and <a href="/wiki/Bitter_orange" title="Bitter orange">bitter oranges</a> may have a similar effect.<a href="#cite_note-129">[129]</a> Furanocoumarins in grapefruit juice (i.e. <a href="/wiki/Bergamottin" title="Bergamottin">bergamottin</a> and <a href="/wiki/6%27,7%27-dihydroxybergamottin" class="mw-redirect" title="6',7'-dihydroxybergamottin">dihydroxybergamottin</a>) inhibit the <a href="/wiki/Cytochrome_P450_oxidase" class="mw-redirect" title="Cytochrome P450 oxidase">cytochrome P450</a> enzyme <a href="/wiki/CYP3A4" title="CYP3A4">CYP3A4</a>, which is involved in the metabolism of most statins (however, it is a major inhibitor of only lovastatin, simvastatin, and to a lesser degree, atorvastatin) and some other medications<a href="#cite_note-Kane2000-130">[130]</a> (flavonoids (i.e. <a href="/wiki/Naringin" title="Naringin">naringin</a>) were thought to be responsible). This increases the levels of the statin, increasing the risk of dose-related adverse effects (including <a href="/wiki/Myopathy" title="Myopathy">myopathy</a>/<a href="/wiki/Rhabdomyolysis" title="Rhabdomyolysis">rhabdomyolysis</a>). The absolute prohibition of grapefruit juice consumption for users of some statins is controversial.<a href="#cite_note-pmid17695563-131">[131]</a> The U.S. <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">Food and Drug Administration</a> (FDA) notified healthcare professionals of updates to the prescribing information concerning interactions between protease inhibitors and certain statin drugs. Protease inhibitors and statins taken together may increase the blood levels of statins and increase the risk for muscle injury (myopathy). The most serious form of myopathy, rhabdomyolysis, can damage the kidneys and lead to kidney failure, which can be fatal.<a href="#cite_note-132">[132]</a> <div class="mw-heading mw-heading3"><h3 id="Osteoporosis_and_fractures">Osteoporosis and fractures</h3>[<a href="/w/index.php?title=Statin&action=edit&section=15" title="Edit section: Osteoporosis and fractures">edit</a>]</div> Studies have found that the use of statins may protect against getting osteoporosis and fractures or may induce osteoporosis and fractures.<a href="#cite_note-133">[133]</a><a href="#cite_note-134">[134]</a><a href="#cite_note-135">[135]</a><a href="#cite_note-136">[136]</a> A cross-sectional retrospective analysis of the entire Austrian population found that the risk of getting osteoporosis is dependent on the dose used.<a href="#cite_note-137">[137]</a> <div class="mw-heading mw-heading2"><h2 id="Mechanism_of_action">Mechanism of action</h2>[<a href="/w/index.php?title=Statin&action=edit&section=16" title="Edit section: Mechanism of action">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Cholesterol#Homeostasis" title="Cholesterol">Cholesterol § Homeostasis</a></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Atorvastatin_binding.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/55/Atorvastatin_binding.png/220px-Atorvastatin_binding.png" decoding="async" width="220" height="157" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/55/Atorvastatin_binding.png/330px-Atorvastatin_binding.png 1.5x, //upload.wikimedia.org/wikipedia/commons/5/55/Atorvastatin_binding.png 2x" data-file-width="432" data-file-height="309" /></a><figcaption>Atorvastatin bound to HMG-CoA reductase: <a href="/wiki/Protein_Data_Bank" title="Protein Data Bank">PDB</a> entry <a rel="nofollow" class="external text" href="https://www.ebi.ac.uk/pdbe/entry/pdb/1hwk">1hwk</a><a href="#cite_note-pmid11349148-138">[138]</a></figcaption></figure> <figure class="skin-invert-image" typeof="mw:File/Thumb"><a href="/wiki/File:HMG-CoA_reductase_pathway.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/1/17/HMG-CoA_reductase_pathway.svg/299px-HMG-CoA_reductase_pathway.svg.png" decoding="async" width="299" height="546" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/17/HMG-CoA_reductase_pathway.svg/449px-HMG-CoA_reductase_pathway.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/1/17/HMG-CoA_reductase_pathway.svg/599px-HMG-CoA_reductase_pathway.svg.png 2x" data-file-width="500" data-file-height="911" /></a><figcaption>The HMG-CoA reductase pathway, which is blocked by statins via inhibiting the rate limiting enzyme <a href="/wiki/HMG-CoA_reductase" title="HMG-CoA reductase">HMG-CoA reductase</a>.</figcaption></figure> Statins act by <a href="/wiki/Competitive_inhibitor" class="mw-redirect" title="Competitive inhibitor">competitively inhibiting</a> <a href="/wiki/HMG-CoA_reductase" title="HMG-CoA reductase">HMG-CoA reductase</a>, the rate-limiting <a href="/wiki/Enzyme" title="Enzyme">enzyme</a> of the <a href="/wiki/Mevalonate_pathway" title="Mevalonate pathway">mevalonate pathway</a>. Because statins are similar in structure to <a href="/wiki/HMG-CoA" title="HMG-CoA">HMG-CoA</a> on a molecular level, they will fit into the enzyme's active site and compete with the native substrate (HMG-CoA). This competition reduces the rate by which <a href="/wiki/HMG-CoA_reductase" title="HMG-CoA reductase">HMG-CoA reductase</a> is able to produce <a href="/wiki/Mevalonate" class="mw-redirect" title="Mevalonate">mevalonate</a>, the next molecule in the <a href="/wiki/Mevalonate_pathway" title="Mevalonate pathway">cascade that eventually produces cholesterol</a>. A variety of natural statins are produced by <a href="/wiki/Penicillium" title="Penicillium">Penicillium</a> and <a href="/wiki/Aspergillus" title="Aspergillus">Aspergillus</a> fungi as <a href="/wiki/Secondary_metabolites" class="mw-redirect" title="Secondary metabolites">secondary metabolites</a>. These natural statins probably function to inhibit HMG-CoA reductase enzymes in bacteria and fungi that compete with the producer.<a href="#cite_note-Endo1992-139">[139]</a> <div class="mw-heading mw-heading3"><h3 id="Inhibiting_cholesterol_synthesis">Inhibiting cholesterol synthesis</h3>[<a href="/w/index.php?title=Statin&action=edit&section=17" title="Edit section: Inhibiting cholesterol synthesis">edit</a>]</div> By inhibiting HMG-CoA reductase, statins block the pathway for synthesizing cholesterol in the liver. This is significant because most circulating cholesterol comes from internal manufacture rather than the diet. When the liver can no longer produce cholesterol, levels of cholesterol in the blood will fall. Cholesterol synthesis appears to occur mostly at night,<a href="#cite_note-140">[140]</a> so statins with short <a href="/wiki/Half-life" title="Half-life">half-lives</a> are usually taken at night to maximize their effect. Studies have shown greater LDL and total cholesterol reductions in the short-acting <a href="/wiki/Simvastatin" title="Simvastatin">simvastatin</a> taken at night rather than the morning,<a href="#cite_note-141">[141]</a><a href="#cite_note-142">[142]</a> but have shown no difference in the long-acting <a href="/wiki/Atorvastatin" title="Atorvastatin">atorvastatin</a>.<a href="#cite_note-143">[143]</a> <div class="mw-heading mw-heading3"><h3 id="Increasing_LDL_uptake">Increasing LDL uptake</h3>[<a href="/w/index.php?title=Statin&action=edit&section=18" title="Edit section: Increasing LDL uptake">edit</a>]</div> In rabbits, <a href="/wiki/Hepatocyte" title="Hepatocyte">liver cells</a> sense the reduced levels of liver cholesterol and seek to compensate by synthesizing <a href="/wiki/LDL_receptor" title="LDL receptor">LDL receptors</a> to draw cholesterol out of the circulation.<a href="#cite_note-Ma1986-144">[144]</a> This is accomplished via <a href="/wiki/Protease" title="Protease">proteases</a> that cleave membrane-bound <a href="/wiki/Sterol_regulatory_element_binding_protein" class="mw-redirect" title="Sterol regulatory element binding protein">sterol regulatory element binding proteins</a>, which then migrate to the <a href="/wiki/Cell_nucleus" title="Cell nucleus">nucleus</a> and bind to the sterol response elements. The sterol response elements then facilitate increased transcription of various other proteins, most notably, <a href="/wiki/LDL_receptor" title="LDL receptor">LDL receptor</a>. The LDL receptor is transported to the liver <a href="/wiki/Cell_membrane" title="Cell membrane">cell membrane</a> and binds to passing <a href="/wiki/Low_density_lipoprotein" class="mw-redirect" title="Low density lipoprotein">LDL</a> and <a href="/wiki/Very_low_density_lipoprotein" class="mw-redirect" title="Very low density lipoprotein">VLDL</a> particles, mediating their uptake into the liver, where the cholesterol is reprocessed into bile salts and other byproducts. This results in a net effect of less LDL circulating in blood.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <div class="mw-heading mw-heading3"><h3 id="Decreasing_of_specific_protein_prenylation">Decreasing of specific protein prenylation</h3>[<a href="/w/index.php?title=Statin&action=edit&section=19" title="Edit section: Decreasing of specific protein prenylation">edit</a>]</div> Statins, by inhibiting the HMG CoA reductase pathway, inhibit downstream synthesis of isoprenoids, such as <a href="/wiki/Farnesyl_pyrophosphate" title="Farnesyl pyrophosphate">farnesyl pyrophosphate</a> and <a href="/wiki/Geranylgeranyl_pyrophosphate" title="Geranylgeranyl pyrophosphate">geranylgeranyl pyrophosphate</a>. Inhibition of protein <a href="/wiki/Prenylation" title="Prenylation">prenylation</a> for proteins such as <a href="/wiki/Transforming_protein_RhoA" title="Transforming protein RhoA">RhoA</a> (and subsequent inhibition of <a href="/wiki/Rho-associated_protein_kinase" title="Rho-associated protein kinase">Rho-associated protein kinase</a>) may be involved, at least partially, in the improvement of endothelial function, modulation of immune function, and other <a href="/wiki/Pleiotropy" title="Pleiotropy">pleiotropic</a> cardiovascular benefits of statins,<a href="#cite_note-145">[145]</a><a href="#cite_note-146">[146]</a><a href="#cite_note-147">[147]</a><a href="#cite_note-:1-148">[148]</a><a href="#cite_note-149">[149]</a><a href="#cite_note-150">[150]</a> as well as in the fact that a number of other drugs that lower LDL have not shown the same cardiovascular risk benefits in studies as statins,<a href="#cite_note-151">[151]</a> and may also account for some of the benefits seen in cancer reduction with statins.<a href="#cite_note-152">[152]</a> In addition, the inhibitory effect on protein prenylation may also be involved in a number of unwanted side effects associated with statins, including muscle pain (myopathy)<a href="#cite_note-153">[153]</a> and elevated blood sugar (diabetes).<a href="#cite_note-154">[154]</a> <div class="mw-heading mw-heading3"><h3 id="Other_effects">Other effects</h3>[<a href="/w/index.php?title=Statin&action=edit&section=20" title="Edit section: Other effects">edit</a>]</div> As noted above, statins exhibit action beyond lipid-lowering activity in the prevention of <a href="/wiki/Atherosclerosis" title="Atherosclerosis">atherosclerosis</a> through so-called "pleiotropic effects of statins".<a href="#cite_note-:1-148">[148]</a> The pleiotropic effects of statins remain controversial.<a href="#cite_note-:2-155">[155]</a> The ASTEROID trial showed direct <a href="/wiki/Intravascular_ultrasound" title="Intravascular ultrasound">ultrasound</a> evidence of <a href="/wiki/Atheroma" title="Atheroma">atheroma</a> regression during statin therapy.<a href="#cite_note-Nissen2006-156">[156]</a> Researchers hypothesize that statins prevent <a href="/wiki/Cardiovascular_disease" title="Cardiovascular disease">cardiovascular disease</a> via four proposed mechanisms (all subjects of a large body of biomedical research):<a href="#cite_note-:2-155">[155]</a> <ol><li>Improve <a href="/wiki/Endothelium" title="Endothelium">endothelial</a> function</li> <li>Modulate <a href="/wiki/Inflammation" title="Inflammation">inflammatory</a> responses</li> <li>Maintain <a href="/wiki/Atherosclerosis" title="Atherosclerosis">plaque</a> stability</li> <li>Prevent <a href="/wiki/Thrombosis" title="Thrombosis">blood clot</a> formation</li></ol> In 2008, the <a href="/wiki/JUPITER_trial" title="JUPITER trial">JUPITER trial</a> showed statins provided benefit in those who had no history of <a href="/wiki/Hyperlipidemia" title="Hyperlipidemia">high cholesterol</a> or heart disease, but only in those with elevated high-sensitivity <a href="/wiki/C-reactive_protein" title="C-reactive protein">C-reactive protein</a> (hsCRP) levels, an indicator for inflammation.<a href="#cite_note-Ridker2008-157">[157]</a> The study has been criticized due to perceived flaws in the study design,<a href="#cite_note-158">[158]</a><a href="#cite_note-159">[159]</a><a href="#cite_note-160">[160]</a> although <a href="/wiki/Paul_Ridker" title="Paul Ridker">Paul M. Ridker</a>, lead investigator of the JUPITER trial, has responded to these criticisms at length.<a href="#cite_note-161">[161]</a> Click on genes, proteins and metabolites below to link to respective articles. <a href="#cite_note-WikiPathways-162">[§ 1]</a> <div style="overflow:auto;"> <div class="thumb tleft"> <div class="thumbinner" style="width: 830px;"> <div class="thumbimage" style="width: 828px; height: 743px; overflow: hidden;"> <div style="position: relative; top: -25px; left: -10px; width: px"><div class="noresize">[[File:<div class="noresize thumb tnone" style=";"> <div class="thumbinner" style="overflow:hidden;width:830px;"> <div class="thumbimage" style="overflow:hidden; position:relative; background-color:white;"> <div style=";left:0px; top:0px; width:828px; position:absolute;"> <figure class="mw-default-size mw-halign-right noresize" typeof="mw:File"><a href="/wiki/Statin#Other_effects" title="Go to pathway article"><img alt="Statin_Pathway_WP430" src="//upload.wikimedia.org/wikipedia/commons/f/f6/StatinPathway_WP430.png" decoding="async" width="828" height="743" class="mw-file-element" data-file-width="828" data-file-height="743" usemap="#ImageMap_fd82d813802fabd6" /></a><map name="ImageMap_fd82d813802fabd6"><area href="/wiki/HMGCR" shape="rect" coords="129,126,189,146" alt="go to article" title="go to article" /><area href="/wiki/CYP7A1" shape="rect" coords="348,151,399,171" alt="go to article" title="go to article" /><area href="/wiki/SOAT1" shape="rect" coords="396,185,456,205" alt="go to article" title="go to article" /><area href="/wiki/Dgat1" shape="rect" coords="664,142,724,162" alt="go to article" title="go to article" /><area href="/wiki/LDL_receptor" shape="rect" coords="159,315,219,335" alt="go to article" title="go to article" /><area href="/wiki/SCARB1" shape="rect" coords="446,318,506,338" alt="go to article" title="go to article" /><area href="/wiki/LRP1" shape="rect" coords="288,315,348,335" alt="go to article" 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/><area href="/wiki/APOA5" shape="rect" coords="669,440,729,460" alt="go to article" title="go to article" /><area href="/wiki/Microsomal_triglyceride_transfer_protein" shape="rect" coords="572,314,621,334" alt="go to article" title="go to article" /><area href="/wiki/Diglyceride" shape="rect" coords="583,96,629,116" alt="go to article" title="go to article" /><area href="/wiki/Squalene" shape="rect" coords="127,218,194,238" alt="go to article" title="go to article" /><area href="/wiki/Farnesyl-diphosphate_farnesyltransferase" shape="rect" coords="40,245,91,265" alt="go to article" title="go to article" /><area href="/wiki/Squalene_monooxygenase" shape="rect" coords="202,181,245,201" alt="go to article" title="go to article" /><area href="/wiki/Acyl-CoA" shape="rect" coords="498,114,552,134" alt="go to article" title="go to article" /><area href="/wiki/Acyl-CoA_synthetase" shape="rect" coords="431,76,533,96" alt="go to article" title="go to article" /><area href="/wiki/Protein_disulfide-isomerase" shape="rect" coords="572,294,621,314" alt="go to article" title="go to article" /><area href="/wiki/Cholesterol" shape="rect" coords="359,541,428,560" alt="go to article" title="go to article" /><area href="/wiki/APOA2" shape="rect" coords="522,471,582,491" alt="go to article" title="go to article" /><area href="/wiki/MiR-33" shape="rect" coords="348,666,428,686" alt="go to article" title="go to article" /><area href="/wiki/MiR-33" shape="rect" coords="348,686,428,706" alt="go to article" title="go to article" /></map><figcaption></figcaption></figure></div> </div> <div class="thumbcaption"></div> </div></div>|alt=Statin pathway <a rel="nofollow" class="external text" href="http://www.wikipathways.org/index.php/Pathway:WP430">edit</a>]]</div></div> </div> <div class="thumbcaption"> <div class="magnify"><a href="/wiki/File:StatinPathway_WP430.png" title="File:StatinPathway WP430.png"> </a></div>Statin pathway <a rel="nofollow" class="external text" href="http://www.wikipathways.org/index.php/Pathway:WP430">edit</a> </div> </div> </div> <div style="clear:both;" class=""></div><style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap"><ol class="references"> <li id="cite_note-WikiPathways-162"><a href="#cite_ref-WikiPathways_162-0">^</a> The interactive pathway map can be edited at WikiPathways: <style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://www.wikipathways.org/index.php/Pathway:WP430">"Statin_Pathway_WP430"</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Statin_Pathway_WP430&rft_id=http%3A%2F%2Fwww.wikipathways.org%2Findex.php%2FPathway%3AWP430&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStatin" class="Z3988"> </li> </ol></div></div> </div> As the target of statins, the HMG-CoA reductase, is highly similar between <a href="/wiki/Eukaryota" class="mw-redirect" title="Eukaryota">eukaryota</a> and <a href="/wiki/Archaea" title="Archaea">archaea</a>, statins also act as antibiotics against archaea by inhibiting archaeal mevalonate biosynthesis. This has been shown in vivo and in vitro.<a href="#cite_note-pmid30702149-163">[162]</a> Since patients with a constipation phenotype present with higher abundance of methanogenic archaea in the gut, the use of statins for management of <a href="/wiki/Irritable_bowel_syndrome" title="Irritable bowel syndrome">irritable bowel syndrome</a> has been proposed and may actually be one of the hidden benefits of statin use.<a href="#cite_note-pmid26559904-164">[163]</a><a href="#cite_note-pmid26066650-165">[164]</a> <div class="mw-heading mw-heading2"><h2 id="Available_forms">Available forms</h2>[<a href="/w/index.php?title=Statin&action=edit&section=21" title="Edit section: Available forms">edit</a>]</div> The statins are divided into two groups: <a href="/wiki/Fermentation_(biochemistry)" class="mw-redirect" title="Fermentation (biochemistry)">fermentation</a>-derived and <a href="/wiki/Chemical_synthesis" title="Chemical synthesis">synthetic</a>. Some specific types are listed in the table below. Note that the associated brand names may vary between countries. <table class="wikitable sortable" style="background:white"> <tbody><tr> <th>Statin </th> <th>Image </th> <th>Brand name </th> <th>Derivation </th> <th>Metabolism<a href="#cite_note-safety-63">[63]</a> </th> <th>Half-life </th></tr> <tr> <td><a href="/wiki/Atorvastatin" title="Atorvastatin">Atorvastatin</a></td> <td><figure class="mw-halign-center skin-invert-image" typeof="mw:File"><a href="/wiki/File:Atorvastatin.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/ef/Atorvastatin.svg/150px-Atorvastatin.svg.png" decoding="async" width="150" height="77" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/ef/Atorvastatin.svg/225px-Atorvastatin.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/ef/Atorvastatin.svg/300px-Atorvastatin.svg.png 2x" data-file-width="512" data-file-height="264" /></a><figcaption></figcaption></figure></td> <td>Arkas, Ator, Atoris, Lipitor, Torvast, Totalip</td> <td>Synthetic</td> <td><a href="/wiki/CYP3A4" title="CYP3A4">CYP3A4</a></td> <td>14–19 hours.<a href="#cite_note-McKenney_Ganz_Wiggins_Saseen_2009_pp._253–280-166">[165]</a> </td></tr> <tr> <td><a href="/wiki/Cerivastatin" title="Cerivastatin">Cerivastatin</a></td> <td><figure class="mw-halign-center skin-invert-image" typeof="mw:File"><a href="/wiki/File:Cerivastatin.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f3/Cerivastatin.svg/150px-Cerivastatin.svg.png" decoding="async" width="150" height="84" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f3/Cerivastatin.svg/225px-Cerivastatin.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/f3/Cerivastatin.svg/300px-Cerivastatin.svg.png 2x" data-file-width="512" data-file-height="288" /></a><figcaption></figcaption></figure></td> <td>Baycol, Lipobay (withdrawn from the market in August 2001 due to risk of serious <a href="/wiki/Rhabdomyolysis" title="Rhabdomyolysis">rhabdomyolysis</a>)</td> <td>Synthetic</td> <td>various <a href="/wiki/CYP3A" title="CYP3A">CYP3A</a> isoforms<a href="#cite_note-167">[166]</a></td> <td> </td></tr> <tr> <td><a href="/wiki/Fluvastatin" title="Fluvastatin">Fluvastatin</a></td> <td><figure class="mw-halign-center skin-invert-image" typeof="mw:File"><a href="/wiki/File:Fluvastatin.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/ef/Fluvastatin.svg/150px-Fluvastatin.svg.png" decoding="async" width="150" height="96" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/ef/Fluvastatin.svg/225px-Fluvastatin.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/ef/Fluvastatin.svg/300px-Fluvastatin.svg.png 2x" data-file-width="512" data-file-height="326" /></a><figcaption></figcaption></figure></td> <td>Lescol, Lescol XL, Lipaxan, Primesin</td> <td>Synthetic</td> <td><a href="/wiki/CYP2C9" title="CYP2C9">CYP2C9</a></td> <td>1–3 hours.<a href="#cite_note-McKenney_Ganz_Wiggins_Saseen_2009_pp._253–280-166">[165]</a> </td></tr> <tr> <td><a href="/wiki/Lovastatin" title="Lovastatin">Lovastatin</a></td> <td><figure class="mw-halign-center skin-invert-image" typeof="mw:File"><a href="/wiki/File:Lovastatin.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/5/50/Lovastatin.svg/150px-Lovastatin.svg.png" decoding="async" width="150" height="129" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/50/Lovastatin.svg/225px-Lovastatin.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/50/Lovastatin.svg/300px-Lovastatin.svg.png 2x" data-file-width="512" data-file-height="440" /></a><figcaption></figcaption></figure></td> <td>Altocor, Altoprev, Mevacor</td> <td>Naturally occurring, fermentation-derived compound. It is found in <a href="/wiki/Oyster_mushrooms" class="mw-redirect" title="Oyster mushrooms">oyster mushrooms</a> and <a href="/wiki/Red_yeast_rice" title="Red yeast rice">red yeast rice</a></td> <td><a href="/wiki/CYP3A4" title="CYP3A4">CYP3A4</a></td> <td>1–3 hours.<a href="#cite_note-McKenney_Ganz_Wiggins_Saseen_2009_pp._253–280-166">[165]</a> </td></tr> <tr> <td><a href="/wiki/Mevastatin" title="Mevastatin">Mevastatin</a></td> <td><figure class="mw-halign-center skin-invert-image" typeof="mw:File"><a href="/wiki/File:Mevastatin.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/a8/Mevastatin.svg/150px-Mevastatin.svg.png" decoding="async" width="150" height="128" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/a8/Mevastatin.svg/225px-Mevastatin.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/a8/Mevastatin.svg/300px-Mevastatin.svg.png 2x" data-file-width="512" data-file-height="437" /></a><figcaption></figcaption></figure></td> <td>Compactin</td> <td>Naturally occurring compound found in <a href="/wiki/Red_yeast_rice" title="Red yeast rice">red yeast rice</a></td> <td><a href="/wiki/CYP3A4" title="CYP3A4">CYP3A4</a></td> <td> </td></tr> <tr> <td><a href="/wiki/Pitavastatin" title="Pitavastatin">Pitavastatin</a></td> <td><figure class="mw-halign-center skin-invert-image" typeof="mw:File"><a href="/wiki/File:Pitavastatin.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/c8/Pitavastatin.svg/150px-Pitavastatin.svg.png" decoding="async" width="150" height="86" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/c8/Pitavastatin.svg/225px-Pitavastatin.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/c8/Pitavastatin.svg/300px-Pitavastatin.svg.png 2x" data-file-width="512" data-file-height="292" /></a><figcaption></figcaption></figure></td> <td>Alipza, Livalo, Livazo, Pitava, Zypitamag</td> <td>Synthetic</td> <td><a href="/wiki/CYP2C9" title="CYP2C9">CYP2C9</a> and <a href="/wiki/CYP2C8" title="CYP2C8">CYP2C8</a> (minimally)</td> <td> </td></tr> <tr> <td><a href="/wiki/Pravastatin" title="Pravastatin">Pravastatin</a></td> <td><figure class="mw-halign-center skin-invert-image" typeof="mw:File"><a href="/wiki/File:Pravastatin.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d8/Pravastatin.svg/150px-Pravastatin.svg.png" decoding="async" width="150" height="140" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d8/Pravastatin.svg/225px-Pravastatin.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d8/Pravastatin.svg/300px-Pravastatin.svg.png 2x" data-file-width="512" data-file-height="479" /></a><figcaption></figcaption></figure></td> <td>Aplactin, Lipostat, Prasterol, Pravachol, Pravaselect, Sanaprav, Selectin, Selektine, Vasticor</td> <td>Fermentation-derived (a fermentation product of bacterium Nocardia autotrophica)</td> <td>Non-CYP<a href="#cite_note-168">[167]</a></td> <td>1–3 hours.<a href="#cite_note-McKenney_Ganz_Wiggins_Saseen_2009_pp._253–280-166">[165]</a> </td></tr> <tr> <td><a href="/wiki/Rosuvastatin" title="Rosuvastatin">Rosuvastatin</a></td> <td><figure class="mw-halign-center skin-invert-image" typeof="mw:File"><a href="/wiki/File:Rosuvastatin_structure.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/a/a3/Rosuvastatin_structure.svg/150px-Rosuvastatin_structure.svg.png" decoding="async" width="150" height="69" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/a/a3/Rosuvastatin_structure.svg/225px-Rosuvastatin_structure.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/a/a3/Rosuvastatin_structure.svg/300px-Rosuvastatin_structure.svg.png 2x" data-file-width="512" data-file-height="237" /></a><figcaption></figcaption></figure></td> <td>Colcardiol, Colfri, Crativ, Crestor, Dilivas, Exorta, Koleros, Lipidover, Miastina, Provisacor, Rosastin, Simestat, Staros</td> <td>Synthetic</td> <td><a href="/wiki/CYP2C9" title="CYP2C9">CYP2C9</a> and <a href="/wiki/CYP2C19" title="CYP2C19">CYP2C19</a></td> <td>14–19 hours.<a href="#cite_note-McKenney_Ganz_Wiggins_Saseen_2009_pp._253–280-166">[165]</a> </td></tr> <tr> <td><a href="/wiki/Simvastatin" title="Simvastatin">Simvastatin</a></td> <td><figure class="mw-halign-center skin-invert-image" typeof="mw:File"><a href="/wiki/File:Simvastatin.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/8/89/Simvastatin.svg/150px-Simvastatin.svg.png" decoding="async" width="150" height="129" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/89/Simvastatin.svg/225px-Simvastatin.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/89/Simvastatin.svg/300px-Simvastatin.svg.png 2x" data-file-width="512" data-file-height="440" /></a><figcaption></figcaption></figure></td> <td>Alpheus, Corvatas, Krustat, Lipenil, Lipex, Liponorm, Medipo, Omistat, Rosim, Setorilin, Simbatrix, Sincol, Sinvacor, Sinvalip, Sivastin, Sinvat, Vastgen, Vastin, Xipocol, Zocor</td> <td>Fermentation-derived (simvastatin is a synthetic derivate of a fermentation product of <a href="/wiki/Aspergillus_terreus" title="Aspergillus terreus">Aspergillus terreus</a>)</td> <td><a href="/wiki/CYP3A4" title="CYP3A4">CYP3A4</a></td> <td>1–3 hours.<a href="#cite_note-McKenney_Ganz_Wiggins_Saseen_2009_pp._253–280-166">[165]</a> </td></tr> <tr> <td><a href="/wiki/Atorvastatin/amlodipine" class="mw-redirect" title="Atorvastatin/amlodipine">Atorvastatin + amlodipine</a></td> <td></td> <td>Caduet, Envacar</td> <td>Combination therapy: statin + <a href="/wiki/Calcium_channel_blocker" title="Calcium channel blocker">calcium antagonist</a></td> <td></td> <td> </td></tr> <tr> <td><a href="/wiki/Atorvastatin" title="Atorvastatin">Atorvastatin</a> + <a href="/wiki/Perindopril" title="Perindopril">perindopril</a> + <a href="/wiki/Amlodipine" title="Amlodipine">amlodipine</a></td> <td></td> <td>Lipertance, Triveram<a href="#cite_note-169">[168]</a><a href="#cite_note-170">[169]</a><a href="#cite_note-171">[170]</a></td> <td>Combination therapy: statin + <a href="/wiki/ACE_inhibitor" title="ACE inhibitor">ACE inhibitor</a> + <a href="/wiki/Calcium_channel_blocker" title="Calcium channel blocker">calcium antagonist</a></td> <td></td> <td> </td></tr> <tr> <td><a href="/wiki/Niacin/lovastatin" title="Niacin/lovastatin">Lovastatin + niacin extended-release</a></td> <td></td> <td>Advicor, Mevacor</td> <td>Combination therapy</td> <td></td> <td> </td></tr> <tr> <td><a href="/wiki/Rosuvastatin" title="Rosuvastatin">Rosuvastatin</a> + <a href="/wiki/Ezetimibe" title="Ezetimibe">ezetimibe</a></td> <td></td> <td>Cholecomb, Delipid Plus, Росулип плюс, Rosulip, Rosumibe, Viazet<a href="#cite_note-172">[171]</a><a href="#cite_note-173">[172]</a><a href="#cite_note-174">[173]</a><a href="#cite_note-175">[174]</a></td> <td>Combination therapy: statin + <a href="/wiki/Cholesterol_absorption_inhibitor" title="Cholesterol absorption inhibitor">cholesterol absorption inhibitor</a></td> <td></td> <td> </td></tr> <tr> <td><a href="/wiki/Ezetimibe/simvastatin" title="Ezetimibe/simvastatin">Simvastatin + ezetimibe</a></td> <td></td> <td>Goltor, Inegy, Staticol, Vytorin, Zestan, Zevistat</td> <td>Combination therapy: statin + <a href="/wiki/Cholesterol_absorption_inhibitor" title="Cholesterol absorption inhibitor">cholesterol absorption inhibitor</a></td> <td></td> <td> </td></tr> <tr> <td><a href="/wiki/Niacin/simvastatin" title="Niacin/simvastatin">Simvastatin + niacin extended-release</a></td> <td></td> <td>Simcor, Simcora</td> <td>Combination therapy</td> <td></td> <td> </td></tr></tbody></table> LDL-lowering potency varies between agents. Cerivastatin is the most potent (withdrawn from the market in August 2001 due to risk of serious rhabdomyolysis), followed by (in order of decreasing potency) rosuvastatin, atorvastatin, simvastatin, lovastatin, pravastatin, and fluvastatin.<a href="#cite_note-176">[175]</a> The relative potency of pitavastatin has not yet been fully established, but preliminary studies indicate a potency similar to rosuvastatin.<a href="#cite_note-177">[176]</a> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:Pleurotus_ostreatus_JPG7.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f6/Pleurotus_ostreatus_JPG7.jpg/220px-Pleurotus_ostreatus_JPG7.jpg" decoding="async" width="220" height="165" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f6/Pleurotus_ostreatus_JPG7.jpg/330px-Pleurotus_ostreatus_JPG7.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/f6/Pleurotus_ostreatus_JPG7.jpg/440px-Pleurotus_ostreatus_JPG7.jpg 2x" data-file-width="2272" data-file-height="1704" /></a><figcaption>The <a href="/wiki/Oyster_mushroom" class="mw-redirect" title="Oyster mushroom">oyster mushroom</a>, a culinary mushroom, naturally contains lovastatin.</figcaption></figure> Some types of statins are naturally occurring, and can be found in such foods as <a href="/wiki/Oyster_mushrooms" class="mw-redirect" title="Oyster mushrooms">oyster mushrooms</a> and <a href="/wiki/Red_yeast_rice" title="Red yeast rice">red yeast rice</a>. Randomized controlled trials have found these foodstuffs to reduce circulating cholesterol, but the quality of the trials has been judged to be low.<a href="#cite_note-pmid17302963-178">[177]</a> Due to patent expiration, most of the block-buster branded statins have been generic since 2012, including atorvastatin, the largest-selling<a href="#cite_note-179">[178]</a> branded drug.<a href="#cite_note-180">[179]</a><a href="#cite_note-181">[180]</a><a href="#cite_note-182">[181]</a><a href="#cite_note-183">[182]</a><a href="#cite_note-184">[183]</a><a href="#cite_note-185">[184]</a><a href="#cite_note-186">[185]</a> <table class="wikitable"> <caption>Statin equivalent dosages </caption> <tbody><tr> <th>% LDL reduction (approx.)</th> <th>Atorvastatin</th> <th>Fluvastatin</th> <th>Lovastatin</th> <th>Pravastatin</th> <th>Rosuvastatin</th> <th>Simvastatin </th></tr> <tr> <td>10–20%</td> <td>–</td> <td>20 mg</td> <td>10 mg</td> <td>10 mg</td> <td>–</td> <td>5 mg </td></tr> <tr> <td>20–30%</td> <td>–</td> <td>40 mg</td> <td>20 mg</td> <td>20 mg</td> <td>–</td> <td>10 mg </td></tr> <tr> <td>30–40%</td> <td>10 mg</td> <td>80 mg</td> <td>40 mg</td> <td>40 mg</td> <td>5 mg</td> <td>20 mg </td></tr> <tr> <td>40–45%</td> <td>20 mg</td> <td>–</td> <td>80 mg</td> <td>80 mg</td> <td>5–10 mg</td> <td>40 mg </td></tr> <tr> <td>46–50%</td> <td>40 mg</td> <td>–</td> <td>–</td> <td>–</td> <td>10–20 mg</td> <td>80 mg<a href="#cite_note-187">[a]</a> </td></tr> <tr> <td>50–55%</td> <td>80 mg</td> <td>–</td> <td>–</td> <td>–</td> <td>20 mg</td> <td>– </td></tr> <tr> <td>56–60%</td> <td>–</td> <td>–</td> <td>–</td> <td>–</td> <td>40 mg</td> <td>– </td></tr> <tr> <th colspan="7">Starting dose </th></tr> <tr> <td>Starting dose</td> <td>10–20 mg</td> <td>20 mg</td> <td>10–20 mg</td> <td>40 mg</td> <td>10 mg; 5 mg if hypothyroid, >65 yo, Asian</td> <td>20 mg </td></tr> <tr> <td>If higher LDL reduction goal</td> <td>40 mg if >45%</td> <td>40 mg if >25%</td> <td>20 mg if >20%</td> <td>–</td> <td>20 mg if LDL >190 mg/dL (4.87 mmol/L)</td> <td>40 mg if >45% </td></tr> <tr> <td>Optimal timing</td> <td>Anytime</td> <td>Evening</td> <td>With evening meals</td> <td>Anytime</td> <td>Anytime</td> <td>Evening </td></tr></tbody></table> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239543626"><div class="reflist reflist-lower-alpha"> <div class="mw-references-wrap"><ol class="references"> <li id="cite_note-187"><a href="#cite_ref-187">^</a> 80 mg dose no longer recommended due to increased risk of rhabdomyolysis. </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="History">History</h2>[<a href="/w/index.php?title=Statin&action=edit&section=22" title="Edit section: History">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Statin_development" class="mw-redirect" title="Statin development">Statin development</a></div> The role of cholesterol in the development of cardiovascular disease was elucidated in the second half of the 20th century.<a href="#cite_note-188">[186]</a> This <a href="/wiki/Lipid_hypothesis" title="Lipid hypothesis">lipid hypothesis</a> prompted attempts to reduce cardiovascular disease burden by lowering cholesterol. Treatment consisted mainly of <a href="/wiki/Diet_(nutrition)" title="Diet (nutrition)">dietary measures</a>, such as a <a href="/wiki/Low-fat_diet" title="Low-fat diet">low-fat diet</a>, and poorly tolerated medicines, such as <a href="/wiki/Clofibrate" title="Clofibrate">clofibrate</a>, <a href="/wiki/Cholestyramine" class="mw-redirect" title="Cholestyramine">cholestyramine</a>, and <a href="/wiki/Nicotinic_acid" title="Nicotinic acid">nicotinic acid</a>. Cholesterol researcher Daniel Steinberg writes that while the Coronary Primary Prevention Trial of 1984 demonstrated cholesterol lowering could significantly reduce the risk of heart attacks and angina, physicians, including cardiologists, remained largely unconvinced.<a href="#cite_note-189">[187]</a> Scientists in academic settings and the pharmaceutical industry began trying to develop a drug to reduce cholesterol more effectively. There were several potential targets, with 30 steps in the synthesis of cholesterol from acetyl-coenzyme A.<a href="#cite_note-190">[188]</a> In 1971, <a href="/wiki/Akira_Endo_(biochemist)" title="Akira Endo (biochemist)">Akira Endo</a>, a Japanese biochemist working for the pharmaceutical company <a href="/wiki/Daiichi_Sankyo" title="Daiichi Sankyo">Sankyo</a>, began to investigate this problem. Research had already shown cholesterol is mostly manufactured by the body in the liver with the enzyme HMG-CoA reductase.<a href="#cite_note-Simons-12">[12]</a> Endo and his team reasoned that certain microorganisms may produce inhibitors of the enzyme to defend themselves against other organisms, as <a href="/wiki/Mevalonate" class="mw-redirect" title="Mevalonate">mevalonate</a> is a precursor of many substances required by organisms for the maintenance of their cell walls or <a href="/wiki/Cytoskeleton" title="Cytoskeleton">cytoskeleton</a> (<a href="/wiki/Isoprenoid" class="mw-redirect" title="Isoprenoid">isoprenoids</a>).<a href="#cite_note-Endo1992-139">[139]</a> The first agent they identified was <a href="/wiki/Mevastatin" title="Mevastatin">mevastatin</a> (ML-236B), a molecule produced by the fungus <a href="/wiki/Penicillium_citrinum" title="Penicillium citrinum">Penicillium citrinum</a>.[<a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] A British group isolated the same compound from Penicillium brevicompactum, named it <a href="/wiki/Compactin" class="mw-redirect" title="Compactin">compactin</a>, and published their report in 1976.<a href="#cite_note-191">[189]</a> The British group mentions antifungal properties, with no mention of HMG-CoA reductase inhibition.<a href="#cite_note-192">[190]</a><a href="#cite_note-193">[191]</a> Mevastatin was never marketed, because of its adverse effects of tumors, muscle deterioration, and sometimes death in laboratory dogs. <a href="/wiki/P._Roy_Vagelos" title="P. Roy Vagelos">P. Roy Vagelos</a>, chief scientist and later CEO of <a href="/wiki/Merck_%26_Co" class="mw-redirect" title="Merck & Co">Merck & Co</a>, was interested, and made several trips to Japan starting in 1975. By 1978, Merck had isolated <a href="/wiki/Lovastatin" title="Lovastatin">lovastatin</a> (mevinolin, MK803) from the fungus <a href="/wiki/Aspergillus_terreus" title="Aspergillus terreus">Aspergillus terreus</a>, first marketed in 1987 as Mevacor.<a href="#cite_note-Simons-12">[12]</a> In the 1990s, as a result of public campaigns, people in the United States became familiar with their cholesterol numbers and the difference between HDL and LDL cholesterol, and various pharmaceutical companies began producing their own statins, such as pravastatin (Pravachol), manufactured by Sankyo and <a href="/wiki/Bristol-Myers_Squibb" class="mw-redirect" title="Bristol-Myers Squibb">Bristol-Myers Squibb</a>. In April 1994, the results of a Merck-sponsored study, the <a href="/wiki/Scandinavian_Simvastatin_Survival_Study" title="Scandinavian Simvastatin Survival Study">Scandinavian Simvastatin Survival Study</a>, were announced. Researchers tested <a href="/wiki/Simvastatin" title="Simvastatin">simvastatin</a>, later sold by Merck as Zocor, on 4,444 patients with high cholesterol and heart disease. After five years, the study concluded the patients saw a 35% reduction in their cholesterol, and their chances of dying of a heart attack were reduced by 42%.<a href="#cite_note-Simons-12">[12]</a><a href="#cite_note-4S-194">[192]</a> In 1995, Zocor and Mevacor both made Merck over US$1 billion.<a href="#cite_note-Simons-12">[12]</a> Though he did not profit from his original discovery, Endo was awarded the 2006 <a href="/wiki/Japan_Prize" title="Japan Prize">Japan Prize</a>, and the <a href="/wiki/Lasker-DeBakey_Clinical_Medical_Research_Award" class="mw-redirect" title="Lasker-DeBakey Clinical Medical Research Award">Lasker-DeBakey Clinical Medical Research Award</a> in 2008, for his pioneering research.<a href="#cite_note-195">[193]</a> Endo was also inducted into the <a href="/wiki/National_Inventors_Hall_of_Fame" title="National Inventors Hall of Fame">National Inventors Hall of Fame</a> in Alexandria, Virginia in 2012. <a href="/wiki/Michael_S._Brown" class="mw-redirect" title="Michael S. Brown">Michael S. Brown</a> and <a href="/wiki/Joseph_L._Goldstein" title="Joseph L. Goldstein">Joseph Goldstein</a>, who won the Nobel Prize for related work on cholesterol, said of Endo: "The millions of people whose lives will be extended through statin therapy owe it all to Akira Endo."<a href="#cite_note-196">[194]</a> As of 2016<a class="external text" href="https://en.wikipedia.org/w/index.php?title=Statin&action=edit">[update]</a> misleading claims exaggerating the adverse effects of statins had received widespread media coverage, with a consequent negative impact to public health.<a href="#cite_note-Collins2016-35">[35]</a> Controversy over the effectiveness of statins in the medical literature was amplified in popular media in the early 2010s, leading an estimated 200,000 people in the UK to stop using statins over a six-month period to mid 2016, according to the authors of a study funded by the British Heart Foundation. They estimated that there could be up to 2,000 extra heart attacks or strokes over the following 10 years as a consequence.<a href="#cite_note-197">[195]</a> An unintended effect of the academic statin controversy has been the spread of scientifically questionable <a href="/wiki/Alternative_medicine" title="Alternative medicine">alternative therapies</a>. Cardiologist <a href="/wiki/Steven_Nissen" title="Steven Nissen">Steven Nissen</a> at <a href="/wiki/Cleveland_Clinic" title="Cleveland Clinic">Cleveland Clinic</a> commented "We are losing the battle for the hearts and minds of our patients to Web sites..."<a href="#cite_note-198">[196]</a> promoting unproven medical therapies. <a href="/wiki/Harriet_Hall" title="Harriet Hall">Harriet Hall</a> sees a spectrum of "statin denialism" ranging from <a href="/wiki/Pseudoscience" title="Pseudoscience">pseudoscientific</a> claims to the understatement of benefits and overstatement of side effects, all of which is contrary to the scientific evidence.<a href="#cite_note-199">[197]</a> Several statins have been approved as <a href="/wiki/Generic_drug" title="Generic drug">generic drugs</a> in the United States: <ul><li>Lovastatin (Mevacor) in December 2001<a href="#cite_note-200">[198]</a><a href="#cite_note-201">[199]</a><a href="#cite_note-202">[200]</a></li> <li>Pravastatin (Pravachol) in April 2006<a href="#cite_note-203">[201]</a><a href="#cite_note-204">[202]</a><a href="#cite_note-205">[203]</a></li> <li>Simvastatin (Zocor) in June 2006<a href="#cite_note-206">[204]</a><a href="#cite_note-207">[205]</a><a href="#cite_note-208">[206]</a></li> <li>Atorvastatin (Lipitor) in November 2011<a href="#cite_note-209">[207]</a><a href="#cite_note-210">[208]</a><a href="#cite_note-211">[209]</a><a href="#cite_note-212">[210]</a></li> <li>Fluvastatin (Lescol) in April 2012<a href="#cite_note-213">[211]</a><a href="#cite_note-214">[212]</a></li> <li>Pitavastatin (Livalo) and rosuvastatin (Crestor) in 2016<a href="#cite_note-215">[213]</a><a href="#cite_note-216">[214]</a></li> <li>Ezetimibe/simvastatin (Vytorin) and ezetimibe/atorvastatin (Liptruzet) in 2017<a href="#cite_note-CDER_2017-217">[215]</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="Research">Research</h2>[<a href="/w/index.php?title=Statin&action=edit&section=23" title="Edit section: Research">edit</a>]</div> Clinical studies have been conducted on the use of statins in <a href="/wiki/Dementia" title="Dementia">dementia</a>,<a href="#cite_note-218">[216]</a> <a href="/wiki/Lung_cancer" title="Lung cancer">lung cancer</a>,<a href="#cite_note-Khurana-219">[217]</a> <a href="/wiki/Cataracts" class="mw-redirect" title="Cataracts">nuclear cataracts</a>,<a href="#cite_note-Klein2006-220">[218]</a> <a href="/wiki/Hypertension" title="Hypertension">hypertension</a>,<a href="#cite_note-221">[219]</a><a href="#cite_note-222">[220]</a> and <a href="/wiki/Prostate_cancer" title="Prostate cancer">prostate cancer</a><a href="#cite_note-223">[221]</a> and <a href="/wiki/Breast_cancer" title="Breast cancer">breast cancer</a>.<a href="#cite_note-224">[222]</a> There is no high quality evidence that <a href="/wiki/Statins" class="mw-redirect" title="Statins">statins</a> are useful for <a href="/wiki/Pneumonia" title="Pneumonia">pneumonia</a>.<a href="#cite_note-225">[223]</a> The small number of available trials do not support the use of statins as an adjunctive therapy or as a monotherapy in <a href="/wiki/Multiple_sclerosis" title="Multiple sclerosis">multiple sclerosis</a>.<a href="#cite_note-226">[224]</a> A modelling study in the UK funded by the NIHR found that people aged 70 and older who take statins live longer in good health than those who do not, regardless of whether they have cardiovascular disease.<a href="#cite_note-227">[225]</a><a href="#cite_note-228">[226]</a> <div class="mw-heading mw-heading2"><h2 id="References">References</h2>[<a href="/w/index.php?title=Statin&action=edit&section=24" title="Edit section: References">edit</a>]</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239543626"><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-Cardiovascular_Media-1"><a href="#cite_ref-Cardiovascular_Media_1-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://watchlearnlive.heart.org/?moduleSelect=chldrg">"Cholesterol Drugs"</a>. <a href="/wiki/American_Heart_Association" title="American Heart Association">American Heart Association</a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20200812143713/https://watchlearnlive.heart.org/?moduleSelect=chldrg">Archived</a> from the original on 12 August 2020. Retrieved 24 December 2019.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=American+Heart+Association&rft.atitle=Cholesterol+Drugs&rft_id=https%3A%2F%2Fwatchlearnlive.heart.org%2F%3FmoduleSelect%3Dchldrg&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStatin" class="Z3988"> </li> <li id="cite_note-AlenghatDavis2019-2"><a href="#cite_ref-AlenghatDavis2019_2-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFAlenghatDavis2019" class="citation journal cs1">Alenghat FJ, Davis AM (February 2019). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679800">"Management of Blood Cholesterol"</a>. <a href="/wiki/JAMA" title="JAMA">JAMA</a>. 321 (8): 800–801. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1001%2Fjama.2019.0015">10.1001/jama.2019.0015</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679800">6679800</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/30715135">30715135</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=JAMA&rft.atitle=Management+of+Blood+Cholesterol&rft.volume=321&rft.issue=8&rft.pages=%3Cspan+class%3D%22nowrap%22%3E800-%3C%2Fspan%3E801&rft.date=2019-02&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6679800%23id-name%3DPMC&rft_id=info%3Apmid%2F30715135&rft_id=info%3Adoi%2F10.1001%2Fjama.2019.0015&rft.aulast=Alenghat&rft.aufirst=FJ&rft.au=Davis%2C+AM&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6679800&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStatin" class="Z3988"> </li> <li id="cite_note-3"><a href="#cite_ref-3">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFNational_Clinical_Guideline_Centre_(UK)2014" class="citation book cs1">National Clinical Guideline Centre (UK) (July 2014). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/books/NBK248067/">Lipid Modification: Cardiovascular Risk Assessment and the Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease</a>. 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U.S. <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">Food and Drug Administration</a> (FDA). 1 March 2012. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20130318182724/https://www.fda.gov/Drugs/DrugSafety/ucm293877.htm">Archived</a> from the original on 18 March 2013. 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Alimentary Pharmacology & Therapeutics. 43 (2): 197–212. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1111%2Fapt.13469">10.1111/apt.13469</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737270">4737270</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/26559904">26559904</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Alimentary+Pharmacology+%26+Therapeutics&rft.atitle=Review+article%3A+inhibition+of+methanogenic+archaea+by+statins+as+a+targeted+management+strategy+for+constipation+and+related+disorders&rft.volume=43&rft.issue=2&rft.pages=%3Cspan+class%3D%22nowrap%22%3E197-%3C%2Fspan%3E212&rft.date=2016-01&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4737270%23id-name%3DPMC&rft_id=info%3Apmid%2F26559904&rft_id=info%3Adoi%2F10.1111%2Fapt.13469&rft.aulast=Gottlieb&rft.aufirst=K&rft.au=Wacher%2C+V&rft.au=Sliman%2C+J&rft.au=Pimentel%2C+M&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4737270&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStatin" class="Z3988"> </li> <li id="cite_note-pmid26066650-165"><a href="#cite_ref-pmid26066650_165-0">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFLurie-WeinbergerGophna2015" class="citation journal cs1">Lurie-Weinberger MN, Gophna U (June 2015). <a rel="nofollow" class="external text" href="https://doi.org/10.1371%2Fjournal.ppat.1004833">"Archaea in and on the Human Body: Health Implications and Future Directions"</a>. PLOS Pathogens. 11 (6): e1004833. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1371%2Fjournal.ppat.1004833">10.1371/journal.ppat.1004833</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4466265">4466265</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/26066650">26066650</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=PLOS+Pathogens&rft.atitle=Archaea+in+and+on+the+Human+Body%3A+Health+Implications+and+Future+Directions&rft.volume=11&rft.issue=6&rft.pages=e1004833&rft.date=2015-06&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4466265%23id-name%3DPMC&rft_id=info%3Apmid%2F26066650&rft_id=info%3Adoi%2F10.1371%2Fjournal.ppat.1004833&rft.aulast=Lurie-Weinberger&rft.aufirst=MN&rft.au=Gophna%2C+U&rft_id=https%3A%2F%2Fdoi.org%2F10.1371%252Fjournal.ppat.1004833&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStatin" class="Z3988"> </li> <li id="cite_note-McKenney_Ganz_Wiggins_Saseen_2009_pp._253–280-166">^ <a href="#cite_ref-McKenney_Ganz_Wiggins_Saseen_2009_pp._253–280_166-0">a</a> <a href="#cite_ref-McKenney_Ganz_Wiggins_Saseen_2009_pp._253–280_166-1">b</a> <a href="#cite_ref-McKenney_Ganz_Wiggins_Saseen_2009_pp._253–280_166-2">c</a> <a href="#cite_ref-McKenney_Ganz_Wiggins_Saseen_2009_pp._253–280_166-3">d</a> <a href="#cite_ref-McKenney_Ganz_Wiggins_Saseen_2009_pp._253–280_166-4">e</a> <a href="#cite_ref-McKenney_Ganz_Wiggins_Saseen_2009_pp._253–280_166-5">f</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMcKenneyGanzWigginsSaseen2009" class="citation book cs1">McKenney JM, Ganz P, Wiggins BS, Saseen JS (2009). "Statins". Clinical Lipidology. Elsevier. pp. 253–280. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fb978-141605469-6.50026-3">10.1016/b978-141605469-6.50026-3</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-4160-5469-6" title="Special:BookSources/978-1-4160-5469-6"><bdi>978-1-4160-5469-6</bdi></a>. <q>The elimination half-life of the statins varies from 1 to 3 hours for lovastatin, simvastatin, pravastatin, and fluvastatin, to 14 to 19 hours for atorvastatin and rosuvastatin (see Table 22-1). The longer the half-life of the statin, the longer the inhibition of reductase and thus a greater reduction in LDL cholesterol. However, the impact of inhibiting cholesterol synthesis persists even with statins that have a relatively short half-life. This is due to their ability to reduce blood levels of lipoproteins, which have a half-life of approximately 2 to 3 days. Because of this, all statins may be dosed once daily. The preferable time of administration is in the evening just before the peak in cholesterol synthesis.</q></cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=Statins&rft.btitle=Clinical+Lipidology&rft.pages=%3Cspan+class%3D%22nowrap%22%3E253-%3C%2Fspan%3E280&rft.pub=Elsevier&rft.date=2009&rft_id=info%3Adoi%2F10.1016%2Fb978-141605469-6.50026-3&rft.isbn=978-1-4160-5469-6&rft.aulast=McKenney&rft.aufirst=JM&rft.au=Ganz%2C+P&rft.au=Wiggins%2C+BS&rft.au=Saseen%2C+JS&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStatin" class="Z3988"> </li> <li id="cite_note-167"><a href="#cite_ref-167">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBobergAngerbauerFeyKanhai1997" class="citation journal cs1">Boberg M, Angerbauer R, Fey P, Kanhai WK, Karl W, Kern A, et al. (March 1997). <a rel="nofollow" class="external text" href="http://dmd.aspetjournals.org/cgi/pmidlookup?view=long&pmid=9172950">"Metabolism of cerivastatin by human liver microsomes in vitro. Characterization of primary metabolic pathways and of cytochrome P450 isozymes involved"</a>. Drug Metabolism and Disposition. 25 (3): 321–331. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/9172950">9172950</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Drug+Metabolism+and+Disposition&rft.atitle=Metabolism+of+cerivastatin+by+human+liver+microsomes+in+vitro.+Characterization+of+primary+metabolic+pathways+and+of+cytochrome+P450+isozymes+involved&rft.volume=25&rft.issue=3&rft.pages=%3Cspan+class%3D%22nowrap%22%3E321-%3C%2Fspan%3E331&rft.date=1997-03&rft_id=info%3Apmid%2F9172950&rft.aulast=Boberg&rft.aufirst=M&rft.au=Angerbauer%2C+R&rft.au=Fey%2C+P&rft.au=Kanhai%2C+WK&rft.au=Karl%2C+W&rft.au=Kern%2C+A&rft.au=Ploschke%2C+J&rft.au=Radtke%2C+M&rft_id=http%3A%2F%2Fdmd.aspetjournals.org%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D9172950&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStatin" class="Z3988"> </li> <li id="cite_note-168"><a href="#cite_ref-168">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFJacobsenKirchnerHallenslebenMancinelli1999" class="citation journal cs1">Jacobsen W, Kirchner G, Hallensleben K, Mancinelli L, Deters M, Hackbarth I, et al. 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Retrieved 8 November 2018.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Drug+Metabolism+and+Disposition&rft.atitle=Comparison+of+cytochrome+P-450-dependent+metabolism+and+drug+interactions+of+the+3-hydroxy-3-methylglutaryl-CoA+reductase+inhibitors+lovastatin+and+pravastatin+in+the+liver&rft.volume=27&rft.issue=2&rft.pages=%3Cspan+class%3D%22nowrap%22%3E173-%3C%2Fspan%3E179&rft.date=1999-02&rft_id=info%3Apmid%2F9929499&rft.aulast=Jacobsen&rft.aufirst=W&rft.au=Kirchner%2C+G&rft.au=Hallensleben%2C+K&rft.au=Mancinelli%2C+L&rft.au=Deters%2C+M&rft.au=Hackbarth%2C+I&rft.au=Benet%2C+LZ&rft.au=Sewing%2C+KF&rft.au=Christians%2C+U&rft_id=http%3A%2F%2Fdmd.aspetjournals.org%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D9929499&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStatin" class="Z3988"> </li> <li id="cite_note-169"><a href="#cite_ref-169">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1 cs1-prop-foreign-lang-source"><a rel="nofollow" class="external text" href="https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_000049_043427_FI.pdf&retry=0&sys=m0b1l3">"Triveram"</a> (PDF) (in Italian). <a rel="nofollow" class="external text" href="https://web.archive.org/web/20200812000033/https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_000049_043427_FI.pdf&retry=0&sys=m0b1l3">Archived</a> from the original on 12 August 2020. 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Retrieved 7 February 2020.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Triveram+%282%29&rft_id=https%3A%2F%2Ffarmaci.agenziafarmaco.gov.it%2Faifa%2Fservlet%2FPdfDownloadServlet%3FpdfFileName%3Dfooter_000049_043427_RCP.pdf%26retry%3D0%26sys%3Dm0b1l3&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStatin" class="Z3988"> </li> <li id="cite_note-171"><a href="#cite_ref-171">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1 cs1-prop-foreign-lang-source"><a rel="nofollow" class="external text" href="https://www.gazzettaufficiale.it/eli/id/2019/10/10/19A06231/SG">"Riclassificazione del medicinale per uso umano 'Triveram', ai sensi dell'articolo 8, comma 10, della legge 24 dicembre 1993, n. 537. (Determina n. DG/1422/2019). (19A06231)"</a>. GU Serie Generale n.238 (in Italian). 10 October 2019. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20200810161745/https://www.gazzettaufficiale.it/eli/id/2019/10/10/19A06231/SG">Archived</a> from the original on 10 August 2020. 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Retrieved 7 February 2020.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Cholecomb&rft_id=https%3A%2F%2Ffarmaci.agenziafarmaco.gov.it%2Faifa%2Fservlet%2FPdfDownloadServlet%3FpdfFileName%3Dfooter_001820_043496_FI.pdf%26retry%3D0%26sys%3Dm0b1l3&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStatin" class="Z3988"> </li> <li id="cite_note-173"><a href="#cite_ref-173">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1 cs1-prop-foreign-lang-source"><a rel="nofollow" class="external text" href="https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_001820_043496_RCP.pdf&retry=0&sys=m0b1l3">"Cholecomb (2)"</a> (PDF) (in Italian). <a rel="nofollow" class="external text" href="https://web.archive.org/web/20200812011759/https://farmaci.agenziafarmaco.gov.it/aifa/servlet/PdfDownloadServlet?pdfFileName=footer_001820_043496_RCP.pdf&retry=0&sys=m0b1l3">Archived</a> from the original on 12 August 2020. 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U.S. <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">Food and Drug Administration</a> (FDA). Archived from <a rel="nofollow" class="external text" href="https://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/DrugandBiologicApprovalReports/ANDAGenericDrugApprovals/ucm064074.htm">the original</a> on 12 July 2009. 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Archived from <a rel="nofollow" class="external text" href="http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/DrugandBiologicApprovalReports/ANDAGenericDrugApprovals/ucm064061.htm">the original</a> on 13 January 2017. 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Heart. 110 (21): 1277–1285. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1136%2Fheartjnl-2024-324052">10.1136/heartjnl-2024-324052</a>. <a href="/wiki/ISSN_(identifier)" class="mw-redirect" title="ISSN (identifier)">ISSN</a> <a rel="nofollow" class="external text" href="https://search.worldcat.org/issn/1355-6037">1355-6037</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/39256053">39256053</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Heart&rft.atitle=Lifetime+effects+and+cost-effectiveness+of+statin+therapy+for+older+people+in+the+United+Kingdom%3A+a+modelling+study&rft.volume=110&rft.issue=21&rft.pages=%3Cspan+class%3D%22nowrap%22%3E1277-%3C%2Fspan%3E1285&rft.date=2024-11-01&rft.issn=1355-6037&rft_id=info%3Apmid%2F39256053&rft_id=info%3Adoi%2F10.1136%2Fheartjnl-2024-324052&rft.aulast=Mihaylova&rft.aufirst=Borislava&rft.au=Wu%2C+Runguo&rft.au=Zhou%2C+Junwen&rft.au=Williams%2C+Claire&rft.au=Schlackow%2C+Iryna&rft.au=Emberson%2C+Jonathan&rft.au=Reith%2C+Christina&rft.au=Keech%2C+Anthony&rft.au=Robson%2C+John&rft.au=Parnell%2C+Richard&rft.au=Armitage%2C+Jane&rft.au=Gray%2C+Alastair&rft.au=Simes%2C+John&rft.au=Baigent%2C+Colin&rft_id=https%3A%2F%2Fheart.bmj.com%2Fcontent%2F110%2F21%2F1277&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStatin" class="Z3988"> </li> <li id="cite_note-228"><a href="#cite_ref-228">^</a> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://evidence.nihr.ac.uk/alert/older-people-who-take-statins-live-longer-in-better-health/">"Older people who take statins live longer in better health"</a>. NIHR Evidence. Retrieved 22 January 2025.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=NIHR+Evidence&rft.atitle=Older+people+who+take+statins+live+longer+in+better+health&rft_id=https%3A%2F%2Fevidence.nihr.ac.uk%2Falert%2Folder-people-who-take-statins-live-longer-in-better-health%2F&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStatin" class="Z3988"> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2>[<a href="/w/index.php?title=Statin&action=edit&section=25" title="Edit section: External links">edit</a>]</div> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFBrody2018" class="citation web cs1">Brody JE (16 April 2018). <a rel="nofollow" class="external text" href="https://www.nytimes.com/2018/04/16/well/weighing-the-pros-and-cons-of-statins.html">"Weighing the Pros and Cons of Statins"</a>. <a href="/wiki/The_New_York_Times" title="The New York Times">The New York Times</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=The+New+York+Times&rft.atitle=Weighing+the+Pros+and+Cons+of+Statins&rft.date=2018-04-16&rft.aulast=Brody&rft.aufirst=JE&rft_id=https%3A%2F%2Fwww.nytimes.com%2F2018%2F04%2F16%2Fwell%2Fweighing-the-pros-and-cons-of-statins.html&rfr_id=info%3Asid%2Fen.wikipedia.org%3AStatin" class="Z3988"></li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1129693374">.mw-parser-output .hlist dl,.mw-parser-output .hlist ol,.mw-parser-output .hlist ul{margin:0;padding:0}.mw-parser-output .hlist dd,.mw-parser-output .hlist dt,.mw-parser-output .hlist li{margin:0;display:inline}.mw-parser-output .hlist.inline,.mw-parser-output .hlist.inline dl,.mw-parser-output .hlist.inline ol,.mw-parser-output .hlist.inline ul,.mw-parser-output .hlist dl dl,.mw-parser-output .hlist dl ol,.mw-parser-output .hlist dl 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href="/wiki/ATC_code_A" title="ATC code A">A</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>stomach acid <ul><li><a href="/wiki/Antacid" title="Antacid">Antacids</a></li> <li><a href="/wiki/H2_antagonist" class="mw-redirect" title="H2 antagonist">H2 antagonists</a></li> <li><a href="/wiki/Proton-pump_inhibitor" title="Proton-pump inhibitor">Proton-pump inhibitors</a></li></ul></li> <li><a href="/wiki/Antiemetic" title="Antiemetic">Antiemetics</a></li> <li><a href="/wiki/Laxative" title="Laxative">Laxatives</a></li> <li><a href="/wiki/Antidiarrhoeal" class="mw-redirect" title="Antidiarrhoeal">Antidiarrhoeals</a> / <a href="/wiki/Antipropulsive" title="Antipropulsive">Antipropulsives</a></li> <li><a href="/wiki/Anti-obesity_medication" title="Anti-obesity medication">Anti-obesity drugs</a></li> <li><a href="/wiki/Diabetes_medication" title="Diabetes medication">Diabetes medication</a></li> <li><a href="/wiki/Vitamin" title="Vitamin">Vitamins</a></li> <li><a href="/wiki/Dietary_mineral" class="mw-redirect" title="Dietary mineral">Dietary minerals</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Blood" title="Blood">blood</a> and blood forming organs (<a href="/wiki/ATC_code_B" title="ATC code B">B</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Antithrombotic" title="Antithrombotic">Antithrombotics</a> <ul><li><a href="/wiki/Antiplatelet_drug" title="Antiplatelet drug">Antiplatelets</a></li> <li><a href="/wiki/Anticoagulant" title="Anticoagulant">Anticoagulants</a></li> <li><a href="/wiki/Thrombolytic_drug" class="mw-redirect" title="Thrombolytic drug">Thrombolytics / fibrinolytics</a></li></ul></li> <li><a href="/wiki/Antihemorrhagic" title="Antihemorrhagic">Antihemorrhagics</a> <ul><li><a href="/wiki/Platelet" title="Platelet">Platelets</a></li> <li><a href="/wiki/Coagulation" title="Coagulation">Coagulants</a></li> <li><a href="/wiki/Antifibrinolytic" title="Antifibrinolytic">Antifibrinolytics</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Circulatory_system" title="Circulatory system">cardiovascular system</a> (<a href="/wiki/ATC_code_C" title="ATC code C">C</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>cardiac therapy / <a href="/wiki/Antianginal" title="Antianginal">antianginals</a> <ul><li><a href="/wiki/Cardiac_glycoside" title="Cardiac glycoside">Cardiac glycosides</a></li> <li><a href="/wiki/Antiarrhythmic_agent" title="Antiarrhythmic agent">Antiarrhythmics</a></li> <li><a href="/wiki/Cardiac_stimulant" title="Cardiac stimulant">Cardiac stimulants</a></li></ul></li> <li><a href="/wiki/Antihypertensive_drug" class="mw-redirect" title="Antihypertensive drug">Antihypertensives</a></li> <li><a href="/wiki/Diuretic" title="Diuretic">Diuretics</a></li> <li><a href="/wiki/Vasodilation" title="Vasodilation">Vasodilators</a></li> <li><a href="/wiki/Beta_blocker" title="Beta blocker">Beta blockers</a></li> <li><a href="/wiki/Calcium_channel_blocker" title="Calcium channel blocker">Calcium channel blockers</a></li> <li><a href="/wiki/Renin%E2%80%93angiotensin_system" title="Renin–angiotensin system">renin–angiotensin system</a> <ul><li><a href="/wiki/ACE_inhibitor" title="ACE inhibitor">ACE inhibitors</a></li> <li><a href="/wiki/Angiotensin_II_receptor_antagonist" class="mw-redirect" title="Angiotensin II receptor antagonist">Angiotensin II receptor antagonists</a></li> <li><a href="/wiki/Renin_inhibitor" title="Renin inhibitor">Renin inhibitors</a></li></ul></li> <li><a href="/wiki/Hypolipidemic_agent" class="mw-redirect" title="Hypolipidemic agent">Antihyperlipidemics</a> <ul><li><a class="mw-selflink selflink">Statins</a></li> <li><a href="/wiki/Fibrate" title="Fibrate">Fibrates</a></li> <li><a href="/wiki/Bile_acid_sequestrant" title="Bile acid sequestrant">Bile acid sequestrants</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_skin" title="Human skin">skin</a> (<a href="/wiki/ATC_code_D" title="ATC code D">D</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Emollient" class="mw-redirect" title="Emollient">Emollients</a></li> <li><a href="/wiki/Cicatrizant" class="mw-redirect" title="Cicatrizant">Cicatrizants</a></li> <li><a href="/wiki/Antipruritic" title="Antipruritic">Antipruritics</a></li> <li><a href="/wiki/Antipsoriatic" class="mw-redirect" title="Antipsoriatic">Antipsoriatics</a></li> <li><a href="/wiki/ATC_code_D09" title="ATC code D09">Medicated dressings</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Genitourinary_system" title="Genitourinary system">genitourinary system</a> (<a href="/wiki/ATC_code_G" title="ATC code G">G</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hormonal_contraception" title="Hormonal contraception">Hormonal contraception</a></li> <li><a href="/wiki/Fertility_medication" title="Fertility medication">Fertility agents</a></li> <li><a href="/wiki/Selective_estrogen_receptor_modulator" title="Selective estrogen receptor modulator">Selective estrogen receptor modulators</a></li> <li><a href="/wiki/Sex_steroid" class="mw-redirect" title="Sex steroid">Sex hormones</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Endocrine_system" title="Endocrine system">endocrine system</a> (<a href="/wiki/ATC_code_H" title="ATC code H">H</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hypothalamic%E2%80%93pituitary_hormone" title="Hypothalamic–pituitary hormone">Hypothalamic–pituitary hormones</a></li> <li><a href="/wiki/Corticosteroid" title="Corticosteroid">Corticosteroids</a> <ul><li><a href="/wiki/Glucocorticoid" title="Glucocorticoid">Glucocorticoids</a></li> <li><a href="/wiki/Mineralocorticoid" title="Mineralocorticoid">Mineralocorticoids</a></li></ul></li> <li><a href="/wiki/Sex_steroid" class="mw-redirect" title="Sex steroid">Sex hormones</a></li> <li><a href="/wiki/Thyroid_hormone" class="mw-redirect" title="Thyroid hormone">Thyroid hormones</a> / <a href="/wiki/Antithyroid_agent" title="Antithyroid agent">Antithyroid agents</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Infection" title="Infection">infections</a> and <a href="https://en.wiktionary.org/wiki/infestation" class="extiw" title="wikt:infestation">infestations</a> (<a href="/wiki/ATC_code_J" title="ATC code J">J</a>, <a href="/wiki/ATC_code_P" title="ATC code P">P</a>, <a href="/wiki/ATCvet_code_QI" title="ATCvet code QI">QI</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Antimicrobial" title="Antimicrobial">Antimicrobials</a>: <a href="/wiki/Antibacterial" class="mw-redirect" title="Antibacterial">Antibacterials</a> (<a href="/wiki/Antimycobacterial" title="Antimycobacterial">Antimycobacterials</a>)</li> <li><a href="/wiki/Antifungal_drug" class="mw-redirect" title="Antifungal drug">Antifungals</a></li> <li><a href="/wiki/Antiviral_drug" title="Antiviral drug">Antivirals</a></li> <li><a href="/wiki/Antiparasitic" title="Antiparasitic">Antiparasitics</a> <ul><li><a href="/wiki/Antiprotozoal_agent" class="mw-redirect" title="Antiprotozoal agent">Antiprotozoals</a></li> <li><a href="/wiki/Anthelmintic" title="Anthelmintic">Anthelmintics</a></li> <li><a href="/wiki/Ectoparasiticide" title="Ectoparasiticide">Ectoparasiticides</a></li></ul></li> <li><a href="/wiki/Intravenous_immunoglobulin" class="mw-redirect" title="Intravenous immunoglobulin">Intravenous immunoglobulin</a></li> <li><a href="/wiki/Vaccine" title="Vaccine">Vaccines</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Malignant" class="mw-redirect" title="Malignant">malignant</a> disease (<a href="/wiki/ATC_code_L" title="ATC code L">L01–L02</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Chemotherapy" title="Chemotherapy">Anticancer agents</a> <ul><li><a href="/wiki/Antimetabolite" title="Antimetabolite">Antimetabolites</a></li> <li><a href="/wiki/Alkylating_antineoplastic_agent" title="Alkylating antineoplastic agent">Alkylating</a></li> <li><a href="/wiki/Spindle_poison" title="Spindle poison">Spindle poisons</a></li> <li><a href="/wiki/Antineoplastic" class="mw-redirect" title="Antineoplastic">Antineoplastic</a></li> <li><a href="/wiki/Topoisomerase_inhibitor" title="Topoisomerase inhibitor">Topoisomerase inhibitors</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Immune_system" title="Immune system">immune</a> disease (<a href="/wiki/ATC_code_L" title="ATC code L">L03–L04</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Immunomodulator" class="mw-redirect" title="Immunomodulator">Immunomodulators</a> <ul><li><a href="/wiki/Immunostimulant" title="Immunostimulant">Immunostimulants</a></li> <li><a href="/wiki/Immunosuppressive_drug" title="Immunosuppressive drug">Immunosuppressants</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Muscle" title="Muscle">muscles</a>, <a href="/wiki/Bone" title="Bone">bones</a>, and <a href="/wiki/Joint" title="Joint">joints</a> (<a href="/wiki/ATC_code_M" title="ATC code M">M</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anabolic_steroid" title="Anabolic steroid">Anabolic steroids</a></li> <li><a href="/wiki/Anti-inflammatory" title="Anti-inflammatory">Anti-inflammatories</a> <ul><li><a href="/wiki/Non-steroidal_anti-inflammatory_drug" class="mw-redirect" title="Non-steroidal anti-inflammatory drug">Non-steroidal anti-inflammatory drugs</a></li></ul></li> <li><a href="/wiki/Disease-modifying_antirheumatic_drug" title="Disease-modifying antirheumatic drug">Antirheumatics</a></li> <li><a href="/wiki/Corticosteroid" title="Corticosteroid">Corticosteroids</a></li> <li><a href="/wiki/Muscle_relaxant" title="Muscle relaxant">Muscle relaxants</a></li> <li><a href="/wiki/Bisphosphonate" title="Bisphosphonate">Bisphosphonates</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_brain" title="Human brain">brain</a> and <a href="/wiki/Nervous_system" title="Nervous system">nervous system</a> (<a href="/wiki/ATC_code_N" title="ATC code N">N</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Analgesic" title="Analgesic">Analgesics</a></li> <li><a href="/wiki/Anesthetic" title="Anesthetic">Anesthetics</a> <ul><li><a href="/wiki/General_anaesthetic" title="General anaesthetic">General</a></li> <li><a href="/wiki/Local_anesthetic" title="Local anesthetic">Local</a></li></ul></li> <li><a href="/wiki/Anorectic" title="Anorectic">Anorectics</a></li> <li><a href="/wiki/Antihyperkinetic" class="mw-redirect" title="Antihyperkinetic">Anti-ADHD agents</a></li> <li><a href="/wiki/Addiction_medicine" title="Addiction medicine">Antiaddictives</a></li> <li><a href="/wiki/Anticonvulsant" title="Anticonvulsant">Anticonvulsants</a></li> <li><a href="/wiki/Antidementia_drug" class="mw-redirect" title="Antidementia drug">Antidementia agents</a></li> <li><a href="/wiki/Antidepressant" title="Antidepressant">Antidepressants</a></li> <li><a href="/wiki/Antimigraine_drug" title="Antimigraine drug">Antimigraine agents</a></li> <li><a href="/wiki/Management_of_Parkinson%27s_disease#Medication" title="Management of Parkinson's disease">Antiparkinson agents</a></li> <li><a href="/wiki/Antipsychotic" title="Antipsychotic">Antipsychotics</a></li> <li><a href="/wiki/Anxiolytic" title="Anxiolytic">Anxiolytics</a></li> <li><a href="/wiki/Aphrodisiac" title="Aphrodisiac">Aphrodisiacs</a></li> <li><a href="/wiki/Depressant" title="Depressant">Depressants</a></li> <li><a href="/wiki/Entactogen" class="mw-redirect" title="Entactogen">Entactogens</a></li> <li><a href="/wiki/Entheogen" title="Entheogen">Entheogens</a></li> <li><a href="/wiki/Euphoria" title="Euphoria">Euphoriants</a></li> <li><a href="/wiki/Psychedelics,_dissociatives_and_deliriants" class="mw-redirect" title="Psychedelics, dissociatives and deliriants">Hallucinogens</a> <ul><li><a href="/wiki/Psychedelic_drug" title="Psychedelic drug">Psychedelics</a></li> <li><a href="/wiki/Dissociative" title="Dissociative">Dissociatives</a></li> <li><a href="/wiki/Deliriant" title="Deliriant">Deliriants</a></li></ul></li> <li><a href="/wiki/Hypnotic" title="Hypnotic">Hypnotics</a> / <a href="/wiki/Sedative" title="Sedative">Sedatives</a></li> <li><a href="/wiki/Mood_stabilizer" title="Mood stabilizer">Mood stabilizers</a></li> <li><a href="/wiki/Motivation-enhancing_drug" title="Motivation-enhancing drug">Motivation-enhancing drug</a></li> <li><a href="/wiki/Neuroprotective" class="mw-redirect" title="Neuroprotective">Neuroprotectives</a></li> <li><a href="/wiki/Nootropic" title="Nootropic">Nootropics</a></li> <li><a href="/wiki/Neurotoxin" title="Neurotoxin">Neurotoxins</a></li> <li><a href="/wiki/Orexigenic" class="mw-redirect" title="Orexigenic">Orexigenics</a></li> <li><a href="/wiki/Serenic" title="Serenic">Serenics</a></li> <li><a href="/wiki/Stimulant" title="Stimulant">Stimulants</a></li> <li><a href="/wiki/Wakefulness-promoting_agent" title="Wakefulness-promoting agent">Wakefulness-promoting agents</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Respiratory_system" title="Respiratory system">respiratory system</a> (<a href="/wiki/ATC_code_R" title="ATC code R">R</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Decongestant" title="Decongestant">Decongestants</a></li> <li><a href="/wiki/Bronchodilator" title="Bronchodilator">Bronchodilators</a></li> <li><a href="/wiki/Cough_medicine" class="mw-redirect" title="Cough medicine">Cough medicines</a></li> <li><a href="/wiki/H1_antagonist" title="H1 antagonist">H1 antagonists</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Sense" title="Sense">sensory organs</a> (<a href="/wiki/ATC_code_S" title="ATC code S">S</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ophthalmology" title="Ophthalmology">Ophthalmologicals</a></li> <li><a href="/wiki/Otology" title="Otology">Otologicals</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">other <a href="/wiki/Anatomical_Therapeutic_Chemical_Classification_System" title="Anatomical Therapeutic Chemical Classification System">ATC</a> (<a href="/wiki/ATC_code_V" title="ATC code V">V</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Antidote" title="Antidote">Antidotes</a></li> <li><a href="/wiki/Contrast_medium" class="mw-redirect" title="Contrast medium">Contrast media</a></li> <li><a href="/wiki/Radiopharmacology" title="Radiopharmacology">Radiopharmaceuticals</a></li> <li><a href="/wiki/Dressing_(medicine)" title="Dressing (medicine)">Dressings</a></li> <li><a href="/wiki/Senotherapeutics" class="mw-redirect" title="Senotherapeutics">Senotherapeutics</a></li></ul> </div></td></tr><tr><td class="navbox-abovebelow" colspan="2"><div> <ul><li><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/16px-Symbol_category_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/23px-Symbol_category_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/96/Symbol_category_class.svg/31px-Symbol_category_class.svg.png 2x" data-file-width="180" data-file-height="185" /> <a href="/wiki/Category:Drugs" title="Category:Drugs">Drugs</a></li> <li><a href="/wiki/Category:Pharmacological_classification_systems" title="Category:Pharmacological classification systems">Pharmacological classification systems</a></li> <li><a href="/wiki/Category:ATC_codes" title="Category:ATC codes">ATC codes</a></li> <li><a href="/wiki/File:Symbol_portal_class.svg" class="mw-file-description" title="Portal"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/e/e2/Symbol_portal_class.svg/16px-Symbol_portal_class.svg.png" decoding="async" width="16" height="16" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/e/e2/Symbol_portal_class.svg/23px-Symbol_portal_class.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/e/e2/Symbol_portal_class.svg/31px-Symbol_portal_class.svg.png 2x" data-file-width="180" data-file-height="185" /></a> <a href="/wiki/Portal:Medicine" title="Portal:Medicine">Medicine portal</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-labelledby="Lipid-lowering_agents_(C10)152" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Lipid_modifying_agents" title="Template:Lipid modifying agents"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Lipid_modifying_agents" title="Template talk:Lipid modifying agents"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Lipid_modifying_agents" title="Special:EditPage/Template:Lipid modifying agents"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Lipid-lowering_agents_(C10)152" style="font-size:114%;margin:0 4em"><a href="/wiki/Hypolipidemic_agent" class="mw-redirect" title="Hypolipidemic agent">Lipid-lowering agents</a> (<a href="/wiki/ATC_code_C10" title="ATC code C10">C10</a>)</div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_gastrointestinal_tract" class="mw-redirect" title="Human gastrointestinal tract">GI tract</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cholesterol_absorption_inhibitor" title="Cholesterol absorption inhibitor">Cholesterol absorption inhibitors</a>, <a href="/wiki/NPC1L1" title="NPC1L1">NPC1L1</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Ezetimibe" title="Ezetimibe">Ezetimibe</a></li> <li><a href="/wiki/Hyzetimibe" title="Hyzetimibe">Hyzetimibe</a></li> <li><a href="/wiki/SCH-48461" title="SCH-48461">SCH-48461</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Bile_acid_sequestrant" title="Bile acid sequestrant">Bile acid sequestrants</a>/<a href="/wiki/Ion-exchange_resin" title="Ion-exchange resin">resins</a> (<a href="/wiki/Low-density_lipoprotein" title="Low-density lipoprotein">LDL</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Colesevelam" title="Colesevelam">Colesevelam</a></li> <li><a href="/wiki/Colestilan" title="Colestilan">Colestilan</a></li> <li><a href="/wiki/Colestipol" title="Colestipol">Colestipol</a></li> <li><a href="/wiki/Colestyramine" title="Colestyramine">Colestyramine</a></li> <li><a href="/wiki/Colextran" title="Colextran">Colextran</a></li> <li><a href="/wiki/Dietary_fiber" title="Dietary fiber">Soluble fiber</a> such as <a href="/wiki/Psyllium" title="Psyllium">psyllium</a> and <a href="/wiki/Glucomannan" title="Glucomannan">glucomannan</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Liver" title="Liver">Liver</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a class="mw-selflink selflink">Statins</a> (<a href="/wiki/HMG-CoA_reductase" title="HMG-CoA reductase">HMG-CoA reductase</a>, <a href="/wiki/Low-density_lipoprotein" title="Low-density lipoprotein">LDL</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Atorvastatin" title="Atorvastatin">Atorvastatin</a></li> <li><a href="/wiki/Cerivastatin" title="Cerivastatin">Cerivastatin</a>‡</li> <li><a href="/wiki/Fluvastatin" title="Fluvastatin">Fluvastatin</a></li> <li><a href="/wiki/Lovastatin" title="Lovastatin">Lovastatin</a></li> <li><a href="/wiki/Mevastatin" title="Mevastatin">Mevastatin</a></li> <li><a href="/wiki/Pitavastatin" title="Pitavastatin">Pitavastatin</a></li> <li><a href="/wiki/Pravastatin" title="Pravastatin">Pravastatin</a></li> <li><a href="/wiki/Rosuvastatin" title="Rosuvastatin">Rosuvastatin</a></li> <li><a href="/wiki/Simvastatin" title="Simvastatin">Simvastatin</a>#</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Niacin and derivatives (<a href="/wiki/High-density_lipoprotein" title="High-density lipoprotein">HDL</a> and <a href="/wiki/Low-density_lipoprotein" title="Low-density lipoprotein">LDL</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Acipimox" title="Acipimox">Acipimox</a></li> <li><a href="/wiki/Aluminium_nicotinate" title="Aluminium nicotinate">Aluminium nicotinate</a></li> <li><a href="/wiki/Nicotinic_acid" title="Nicotinic acid">Nicotinic acid</a></li> <li><a href="/wiki/Niceritrol" title="Niceritrol">Niceritrol</a></li> <li><a href="/wiki/Nicofuranose" title="Nicofuranose">Nicofuranose</a></li> <li><a href="/wiki/Nicotinyl_alcohol" title="Nicotinyl alcohol">Nicotinyl alcohol</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Microsomal_triglyceride_transfer_protein" title="Microsomal triglyceride transfer protein">MTTP</a> inhibitors (<a href="/wiki/Very_low-density_lipoprotein" title="Very low-density lipoprotein">VLDL</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Dirlotapide" title="Dirlotapide">Dirlotapide</a></li> <li><a href="/wiki/Lomitapide" title="Lomitapide">Lomitapide</a></li> <li><a href="/wiki/Mitratapide" title="Mitratapide">Mitratapide</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/ATP_citrate_lyase" class="mw-redirect" title="ATP citrate lyase">ATP citrate lyase</a> inhibitors (<a href="/wiki/Low-density_lipoprotein" title="Low-density lipoprotein">LDL</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bempedoic_acid" title="Bempedoic acid">Bempedoic acid</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Thyromimetic" title="Thyromimetic">Thyromimetics</a> (VLDL)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Dextrothyroxine" title="Dextrothyroxine">Dextrothyroxine</a>‡</li> <li><a href="/wiki/Resmetirom" title="Resmetirom">Resmetirom</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Blood_vessel" title="Blood vessel">Blood vessels</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/PPAR_agonist" title="PPAR agonist">PPAR agonists</a> (LDL)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Fibrate" title="Fibrate">Fibrates</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Aluminium_clofibrate" title="Aluminium clofibrate">Aluminium clofibrate</a></li> <li><a href="/wiki/Bezafibrate" title="Bezafibrate">Bezafibrate</a></li> <li><a href="/w/index.php?title=Choline_fenofibrate&action=edit&redlink=1" class="new" title="Choline fenofibrate (page does not exist)">Choline fenofibrate</a></li> <li><a href="/wiki/Ciprofibrate" title="Ciprofibrate">Ciprofibrate</a></li> <li><a href="/wiki/Clinofibrate" title="Clinofibrate">Clinofibrate</a></li> <li><a href="/wiki/Clofibrate" title="Clofibrate">Clofibrate</a>‡</li> <li><a href="/wiki/Clofibride" title="Clofibride">Clofibride</a></li> <li><a href="/wiki/Etofibrate" title="Etofibrate">Etofibrate</a></li> <li><a href="/wiki/Fenofibrate" title="Fenofibrate">Fenofibrate</a></li> <li><a href="/wiki/Gemfibrozil" title="Gemfibrozil">Gemfibrozil</a></li> <li><a href="/wiki/Nafenopin" title="Nafenopin">Nafenopin</a></li> <li><a href="/wiki/Pemafibrate" title="Pemafibrate">Pemafibrate</a></li> <li><a href="/wiki/Ronifibrate" title="Ronifibrate">Ronifibrate</a></li> <li><a href="/wiki/Simfibrate" title="Simfibrate">Simfibrate</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Others</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/GW501516" title="GW501516">GW501516</a>§</li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/CETP_inhibitor" title="CETP inhibitor">CETP inhibitors</a> (<a href="/wiki/High-density_lipoprotein" title="High-density lipoprotein">HDL</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anacetrapib" title="Anacetrapib">Anacetrapib</a>†</li> <li><a href="/wiki/Dalcetrapib" title="Dalcetrapib">Dalcetrapib</a>§</li> <li><a href="/wiki/Evacetrapib" title="Evacetrapib">Evacetrapib</a>§</li> <li><a href="/wiki/Obicetrapib" title="Obicetrapib">Obicetrapib</a>†</li> <li><a href="/wiki/Torcetrapib" title="Torcetrapib">Torcetrapib</a>§</li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/PCSK9_inhibitor" class="mw-redirect" title="PCSK9 inhibitor">PCSK9 inhibitors</a> (<a href="/wiki/Low-density_lipoprotein" title="Low-density lipoprotein">LDL</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alirocumab" title="Alirocumab">Alirocumab</a></li> <li><a href="/wiki/Bococizumab" title="Bococizumab">Bococizumab</a></li> <li><a href="/wiki/Evolocumab" title="Evolocumab">Evolocumab</a></li> <li><a href="/wiki/Inclisiran" title="Inclisiran">Inclisiran</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/ANGPTL3" title="ANGPTL3">ANGPTL3</a> inhibitors (<a href="/wiki/Low-density_lipoprotein" title="Low-density lipoprotein">LDL</a>/<a href="/wiki/High-density_lipoprotein" title="High-density lipoprotein">HDL</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Evinacumab" title="Evinacumab">Evinacumab</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Combinations</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Amlodipine/atorvastatin" title="Amlodipine/atorvastatin">Amlodipine/atorvastatin</a></li> <li><a href="/wiki/Bempedoic_acid/ezetimibe" title="Bempedoic acid/ezetimibe">Bempedoic acid/ezetimibe</a></li> <li><a href="/wiki/Ezetimibe/atorvastatin" title="Ezetimibe/atorvastatin">Ezetimibe/atorvastatin</a></li> <li><a href="/wiki/Ezetimibe/rosuvastatin" title="Ezetimibe/rosuvastatin">Ezetimibe/rosuvastatin</a></li> <li><a href="/wiki/Ezetimibe/simvastatin" title="Ezetimibe/simvastatin">Ezetimibe/simvastatin</a></li> <li><a href="/wiki/Fenofibrate/pravastatin" title="Fenofibrate/pravastatin">Fenofibrate/pravastatin</a></li> <li><a href="/wiki/Fenofibrate/simvastatin" title="Fenofibrate/simvastatin">Fenofibrate/simvastatin</a></li> <li><a href="/wiki/Laropiprant" title="Laropiprant">Niacin/laropiprant</a></li> <li><a href="/wiki/Niacin/lovastatin" title="Niacin/lovastatin">Niacin/lovastatin</a></li> <li><a href="/wiki/Niacin/simvastatin" title="Niacin/simvastatin">Niacin/simvastatin</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alipogene_tiparvovec" title="Alipogene tiparvovec">Alipogene tiparvovec</a></li> <li><a href="/wiki/Azacosterol" title="Azacosterol">Azacosterol</a></li> <li><a href="/wiki/Azalanstat" title="Azalanstat">Azalanstat</a></li> <li><a href="/wiki/Benfluorex" title="Benfluorex">Benfluorex</a>‡</li> <li><a href="/wiki/Darapladib" title="Darapladib">Darapladib</a>§</li> <li><a href="/wiki/Lapaquistat" title="Lapaquistat">Lapaquistat</a>§</li> <li><a href="/wiki/Magnesium_pyridoxal_5-phosphate_glutamate" title="Magnesium pyridoxal 5-phosphate glutamate">Magnesium pyridoxal 5-phosphate glutamate</a></li> <li><a href="/wiki/Meglutol" title="Meglutol">Meglutol</a></li> <li><a href="/wiki/Mipomersen" title="Mipomersen">Mipomersen</a></li> <li><a href="/wiki/Omega-3-acid_ethyl_esters" title="Omega-3-acid ethyl esters">Omega−3-acid ethyl esters</a></li> <li><a href="/wiki/Policosanol" title="Policosanol">Policosanol</a></li> <li><a href="/wiki/Probucol" title="Probucol">Probucol</a></li> <li><a href="/wiki/Tiadenol" title="Tiadenol">Tiadenol</a></li> <li><a href="/wiki/Triparanol" title="Triparanol">Triparanol</a>‡</li> <li><a href="/wiki/Volanesorsen" title="Volanesorsen">Volanesorsen</a></li></ul> </div></td></tr><tr><td colspan="2" class="navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist"> <ul><li>#<a href="/wiki/WHO_Model_List_of_Essential_Medicines" title="WHO Model List of Essential Medicines">WHO-EM</a></li> <li>‡<a href="/wiki/List_of_withdrawn_drugs" title="List of withdrawn drugs">Withdrawn</a> from market</li> <li><a href="/wiki/Clinical_trial" title="Clinical trial">Clinical trials</a>: <ul><li>†<a href="/wiki/Phases_of_clinical_research#Phase_III" title="Phases of clinical research">Phase III</a></li> <li>§Never to phase III</li></ul></li></ul> </div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Pharmacology:_enzyme_inhibition70" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Enzyme_inhibition" title="Template:Enzyme inhibition"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Enzyme_inhibition" title="Template talk:Enzyme inhibition"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Enzyme_inhibition" title="Special:EditPage/Template:Enzyme inhibition"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Pharmacology:_enzyme_inhibition70" style="font-size:114%;margin:0 4em"><a href="/wiki/Pharmacology" title="Pharmacology">Pharmacology</a>: <a href="/wiki/Enzyme_inhibitor" title="Enzyme inhibitor">enzyme inhibition</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Class</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Competitive_inhibition" title="Competitive inhibition">Competitive inhibition</a></li> <li><a href="/wiki/Uncompetitive_inhibitor" class="mw-redirect" title="Uncompetitive inhibitor">Uncompetitive inhibition</a></li> <li><a href="/wiki/Non-competitive_inhibition" title="Non-competitive inhibition">Non-competitive inhibition</a></li> <li><a href="/wiki/Suicide_inhibition" title="Suicide inhibition">Suicide inhibition</a></li> <li><a href="/wiki/Mixed_inhibition" title="Mixed inhibition">Mixed inhibition</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Substrate</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Oxidoreductase" title="Oxidoreductase">Oxidoreductase</a> (EC 1)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>1.1 <a href="/wiki/Aldose_reductase_inhibitor" title="Aldose reductase inhibitor">Aldose reductase</a></li> <li><a class="mw-selflink selflink">HMG-CoA reductase</a></li></ul> <ul><li>1.3 <a href="/wiki/5%CE%B1-Reductase_inhibitor" title="5α-Reductase inhibitor">5α-Reductase</a></li></ul> <ul><li>1.4 <a href="/wiki/Monoamine_oxidase_inhibitor" title="Monoamine oxidase inhibitor">Monoamine oxidase</a></li></ul> <ul><li>1.5 <a href="/wiki/Dihydrofolate_reductase_inhibitor" title="Dihydrofolate reductase inhibitor">Dihydrofolate reductase</a></li></ul> <ul><li>1.13 <a href="/wiki/Lipoxygenase_inhibitor" class="mw-redirect" title="Lipoxygenase inhibitor">Lipoxygenase</a></li></ul> <ul><li>1.14 <a href="/wiki/Aromatase_inhibitor" title="Aromatase inhibitor">Aromatase</a></li> <li><a href="/wiki/COX-2_inhibitor" class="mw-redirect" title="COX-2 inhibitor">COX-2</a></li></ul> <ul><li>1.17 <a href="/wiki/Xanthine_oxidase_inhibitor" title="Xanthine oxidase inhibitor">Xanthine oxidase</a></li> <li><a href="/wiki/Ribonucleotide_reductase_inhibitor" title="Ribonucleotide reductase inhibitor">Ribonucleotide reductase</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Transferase" title="Transferase">Transferase</a> (EC 2)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>2.1 <a href="/wiki/COMT_inhibitor" class="mw-redirect" title="COMT inhibitor">COMT</a></li> <li><a href="/wiki/Thymidylate_synthase_inhibitor" title="Thymidylate synthase inhibitor">Thymidylate synthase</a></li></ul> <ul><li>2.4 <a href="/wiki/PARP_inhibitor" title="PARP inhibitor">PARP</a></li></ul> <ul><li>2.5 <a href="/wiki/Dihydropteroate_synthase_inhibitor" title="Dihydropteroate synthase inhibitor">Dihydropteroate synthetase</a></li> <li><a href="/wiki/Farnesyltransferase_inhibitor" title="Farnesyltransferase inhibitor">Farnesyltransferase</a></li></ul> <ul><li>2.6 <a href="/wiki/GABA_transaminase_inhibitor" title="GABA transaminase inhibitor">GABA transaminase</a></li></ul> <ul><li>2.7 <a href="/wiki/Nucleotidyltransferase" title="Nucleotidyltransferase">Nucleotidyltransferase</a> <ul><li><a href="/wiki/Integrase_inhibitor" title="Integrase inhibitor">Integrase</a></li> <li><a href="/wiki/Reverse-transcriptase_inhibitor" title="Reverse-transcriptase inhibitor">Reverse transcriptase</a></li></ul></li> <li><a href="/wiki/Protein_kinase_inhibitor" title="Protein kinase inhibitor">Protein kinase</a> <ul><li><a href="/wiki/Tyrosine_kinase_inhibitor" title="Tyrosine kinase inhibitor">Tyrosine kinase</a> <ul><li><a href="/wiki/Janus_kinase_inhibitor" title="Janus kinase inhibitor">Janus kinase</a></li></ul></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hydrolase" title="Hydrolase">Hydrolase</a> (EC 3)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>3.1 <a href="/wiki/Phosphodiesterase_inhibitor" title="Phosphodiesterase inhibitor">Phosphodiesterase</a></li> <li><a href="/wiki/Acetylcholinesterase_inhibitor" title="Acetylcholinesterase inhibitor">Acetylcholinesterase</a></li> <li><a href="/wiki/Ribonuclease_inhibitor" title="Ribonuclease inhibitor">Ribonuclease</a></li></ul> <ul><li>3.2 <a href="/wiki/Polygalacturonase_inhibitor" title="Polygalacturonase inhibitor">Polygalacturonase</a></li> <li><a href="/wiki/Neuraminidase_inhibitor" title="Neuraminidase inhibitor">Neuraminidase</a></li> <li><a href="/wiki/Alpha-glucosidase_inhibitor" title="Alpha-glucosidase inhibitor">Alpha-glucosidase</a></li></ul> <ul><li>3.4 <a href="/wiki/Protease_inhibitor_(pharmacology)" title="Protease inhibitor (pharmacology)">Protease</a>: <a href="/wiki/Exopeptidase_inhibitor" title="Exopeptidase inhibitor">Exopeptidase</a> <ul><li><a href="/wiki/Dipeptidyl_peptidase-4_inhibitor" title="Dipeptidyl peptidase-4 inhibitor">DPP-4</a></li> <li><a href="/wiki/ACE_inhibitor" title="ACE inhibitor">ACE</a></li></ul></li> <li><a href="/wiki/Endopeptidase_inhibitor" title="Endopeptidase inhibitor">Endopeptidase</a> <ul><li><a href="/wiki/Trypsin_inhibitor" title="Trypsin inhibitor">Trypsin</a></li> <li><a href="/wiki/Renin_inhibitor" title="Renin inhibitor">Renin</a></li></ul></li> <li>Mixed <ul><li><a href="/wiki/Enkephalinase_inhibitor" title="Enkephalinase inhibitor">Enkephalinase</a></li> <li><a href="/wiki/Matrix_metalloproteinase_inhibitor" title="Matrix metalloproteinase inhibitor">Matrix metalloproteinase</a></li> <li><a href="/wiki/Oxytocinase_inhibitor" class="mw-redirect" title="Oxytocinase inhibitor">Oxytocinase</a></li></ul></li></ul> <ul><li>3.5 <a href="/wiki/Histone_deacetylase_inhibitor" title="Histone deacetylase inhibitor">Histone deacetylase</a></li> <li><a href="/wiki/Beta-lactamase_inhibitor" class="mw-redirect" title="Beta-lactamase inhibitor">Beta-lactamase</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Lyase" title="Lyase">Lyase</a> (EC 4)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>4.1 <a href="/wiki/Dopa_decarboxylase_inhibitor" class="mw-redirect" title="Dopa decarboxylase inhibitor">Dopa decarboxylase</a></li></ul> <ul><li>4.2 <a href="/wiki/Carbonic_anhydrase_inhibitor" title="Carbonic anhydrase inhibitor">Carbonic anhydrase</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Miscellaneous</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Steroidogenesis_inhibitor" title="Steroidogenesis inhibitor">Steroidogenesis inhibitor</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <style data-mw-deduplicate="TemplateStyles:r1130092004">.mw-parser-output .portal-bar{font-size:88%;font-weight:bold;display:flex;justify-content:center;align-items:baseline}.mw-parser-output .portal-bar-bordered{padding:0 2em;background-color:#fdfdfd;border:1px solid #a2a9b1;clear:both;margin:1em auto 0}.mw-parser-output .portal-bar-related{font-size:100%;justify-content:flex-start}.mw-parser-output .portal-bar-unbordered{padding:0 1.7em;margin-left:0}.mw-parser-output .portal-bar-header{margin:0 1em 0 0.5em;flex:0 0 auto;min-height:24px}.mw-parser-output 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