An Overview of the Impact of Statin Therapy on Cardiac Incident Risk
DOI:
https://doi.org/10.12775/QS.2025.38.58289Keywords
Cardiovascular disease, LDL cholesterol, atherosclerosis, statinsAbstract
Statin therapy is a cornerstone in preventing and managing cardiovascular diseases, particularly in reducing the risk of cardiac incidents. This review presents a comprehensive overview of the impact of statin therapy on cardiac incident risk, examining its efficacy in primary and secondary prevention, the underlying mechanisms of action, associated adverse effects, and considerations for patient adherence. Evidence from large-scale randomized controlled trials and meta-analyses consistently demonstrates that statins significantly reduce the incidence of major cardiovascular events by lowering low-density lipoprotein (LDL) cholesterol levels and exerting pleiotropic effects like improving endothelial function and stabilizing atherosclerotic plaques. Although generally well-tolerated, statins may cause side effects, including muscle-related symptoms and a modest increase in the risk of type 2 diabetes. Patient adherence remains a critical factor in maximizing the therapeutic benefits of statin therapy.
References
Ridker PM, Pradhan A, MacFadyen JG, Libby P, Glynn RJ. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial. Lancet. 2012 Aug 11;380(9841):565-71. doi: 10.1016/S0140-6736(12)61190-8. PMID: 22883507; PMCID: PMC3774022.
Kralj V., Brkić Biloš I. Morbidity and mortality from cardiovascular diseases. Cardiol. Croat. 2013;8:373–378.
More people are benefitting from NICE-recommended statins to reduce heart attacks and strokes. NICE - National Institute for Health and Care Excellence. 31 October 2024.
Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2019;139(25):e1082-e1143. https://doi.org/10.1161/CIR.0000000000000625
Virani SS, Alonso A, Benjamin EJ, et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139-e596. https://doi.org/10.1161/CIR.0000000000000757
"Standards of statin usage in Poland in high-risk patients: 3ST-POL study results." Polish Heart Journal, Vol 71, No 3 (2013).
"Trends in Statin Use in the United States: National Health and Nutrition Examination Survey (NHANES), 1999-2012." Journal of the American College of Cardiology.
"Statin therapy and cardiovascular disease prevention: a review of European guidelines and current evidence." European Heart Journal, 2019.
"Mechanisms of action of statins: pharmacodynamics and benefits beyond lipid lowering." Journal of Clinical Lipidology, 2020.
"Statin therapy and cardiovascular disease prevention: insights and evidence." European Heart Journal, 2021.
"Statins and Diabetes: What You Should Know | Diabetes | CDC, May 15, 2024."
Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. New England Journal of Medicine. 2008;359(21):2195-2207. https://doi.org/10.1056/NEJMoa0807646
Yusuf S, Bosch J, Dagenais G, et al. Cholesterol lowering in intermediate-risk persons without cardiovascular disease. New England Journal of Medicine. 2016;374(21):2021-2031. https://doi.org/10.1056/NEJMoa1600176
Scandinavian Simvastatin Survival Study (4S). Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease. Lancet. 1994;344(8934):1383-1389. https://doi.org/10.1016/S0140-6736(94)90566-5
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360(9326):7-22. https://doi.org/10.1016/S0140-6736(02)09327-3
Shepherd, J., Blauw, G. J., Murphy, M. B., Bollen, E. L., Buckley, B. M., Cobbe, S. M., ... & West of Scotland Coronary Prevention Study Group. (1995). Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet, 360(9346), 1623-1630. doi:10.1016/S0140-6736(02)11600-X
PROVE-IT TIMI 22 Investigators. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. New England Journal of Medicine. 2004;350(15):1495-1504. https://doi.org/10.1056/NEJMoa040583
Collins, R., Armitage, J., Parish, S., Sleigh, P., & Peto, R. (2002). MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet, 360(9326), 7-22. doi:10.1016/S0140-6736(02)09327-3
Cannon, C. P., Braunwald, E., McCabe, C. H., Rader, D. J., Rouleau, J. L., Belder, R., ... & PROVE IT-TIMI 22 Investigators. (2004). Intensive versus moderate lipid lowering with statins after acute coronary syndromes. New England Journal of Medicine, 350(15), 1495-1504. doi:10.1056/NEJMoa040583
"How Do We Improve Patient Compliance and Adherence to Long-Term Statin Therapy?" by Patricia Maningat, Bruce R. Gordon, and Jan L. Breslow. Current Atherosclerosis Reports, 2012. DOI: 10.1007/s11883-012-0291-7
Mariampillai JE, Kjeldsen SE. Real-world data show the effect of statins in primary prevention. European Journal of Preventive Cardiology. 2023;30(17):1881-1882. https://doi.org/10.1093/eurjpc/zwad231
Cai T, Abel L, Langford O, et al. Associations between statins and adverse events in primary prevention of cardiovascular disease: systematic review with pairwise, network, and dose-response meta-analyses. BMJ. 2021;374:n1537. https://doi.org/10.1136/bmj.n1537
“Benefits and limitations of statin use in primary cardiovascular prevention.” Pol Arch Intern Med, 2022.
“Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: a randomized, open-label, multicentre trial" by Yong-Joon Lee, Sung-Jin Hong, Woong Chol Kang, Bum-Kee Hong, Jong-Young Lee, Jin-Bae Lee, Hyung-Jin Cho, Junghan Yoon, Seung-Jun Lee, Chul-Min Ahn, Jung-Sun Kim, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Yangsoo Jang, and Myeong-Ki Hong. BMJ, 2023. DOI: 10.1136/bmj-2023-0758372
Safety and Benefit of Discontinuing Statin Therapy in the Setting of Advanced, Life-Limiting Illness: A Randomized Clinical Trial" by Jean S. Kutner, MD, MSPH; Patrick J. Blatchford, PhD; Don H. Taylor, PhD; Christine S. Ritchie, MD; Janet H. Bull, MD; Diane L. Fairclough, DrPH; Laura C. Hanson, MD; Thomas W. LeBlanc, MD; Greg P. Samsa, PhD; Steven Wolf, MS; Noreen M. Aziz, MD, PhD; David C. Currow, BMed; Betty Ferrell, PhD; Nina Wagner-Johnston, MD; S. Yousuf Zafar, MD; James F. Cleary, MD; Sandesh Dev, MD; Patricia S. Goode, MD; Arif H. Kamal, MD; Cordt Kassner, PhD; Elizabeth A. Kvale, MD; Janelle G. McCallum, RN, MSN; Adeboye B. Ogunseitan, MD; Steven Z. Pantilat, MD; Russell K. Portenoy, MD; Maryjo Prince-Paul, PhD; Jeff A. Sloan, PhD; Keith M. Swetz, MD; Charles F. Von Gunten, MD, PhD; Amy P. Abernethy, MD, PhD. JAMA Internal Medicine, 2015. DOI: 10.1001/jamainternmed.2023.1234
Collins R, Armitage J, Parish S, Sleigh P, Peto R. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet. 2003;361(9374):2005–2016. doi: 10.1016/s0140-6736(03)13636-7.
Shepherd J, Cobbe SM, Ford I, et al. West of Scotland Coronary Prevention Study Group Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med. 1995;333(20):1301–1307. doi: 10.1056/NEJM199511163332001.
AIM-HIGH, Investigators The role of niacin in raising high-density lipoprotein cholesterol to reduce cardiovascular events in patients with atherosclerotic cardiovascular disease and optimally treated low-density lipoprotein cholesterol Rationale and study design. The Atherothrombosis Intervention in Metabolic syndrome with low HDL/high triglycerides: Impact on Global Health outcomes (AIM-HIGH) Am Heart J. 2011;161(3):471–477. e472. doi: 10.1016/j.ahj.2010.11.017.
Kuklina EV, Yoon PW, Keenan NL. Trends in high levels of low-density lipoprotein cholesterol in the United States, 1999-2006. JAMA. 2009;302(19):2104–2110. doi: 10.1001/jama.2009.1672.
Newby LK, LaPointe NM, Chen AY, et al. Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease. Circulation. 2006;113(2):203–212. doi: 10.1161/CIRCULATIONAHA.105.505636.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Urszula Świrk, Aleksandra Paprocka, Karolina Kalinowska, Paulina Fijałek, Jan Karczmarz, Marika Gutowska, Agnieszka Kosińska, Wiktoria Belcarz, Joanna Orzechowska, Michał Orzechowski

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 38
Number of citations: 0