Appropriate use of high intensity statins

Abstract

The use of statins to reduce the levels of cholesterol linked to low-density lipoproteins and thus decrease cardiovascular events is one of the most relevant advances in cardiovascular prevention in recent decades. The magnitude of these changes in the lipid profile will depend on the type of statin and the dose used; those that are able to decrease 50% or more low-density lipoproteins levels are called “high-intensity statins”.
In recent decades, the evidence from large randomized clinical trials with statins shows that lowering cholesterol reduces cardiovascular mortality, the incidence of acute myocardial infarction and cerebrovascular accident. The first clinical trials comparedmoderate-intensity statins versus placebo. Subsequently, somestudies hypothesized that using higher potency statins would show a greater reduction in cardiovascular events compared to less intensive regimens. Also, several trials have studied whether the use of high intensity statins impacts the progression of atherosclerosis.
In this review, the evidence that supports the recommendations for the use of high intensity statins according to the different clinical practice guidelines in primary and secondary prevention is analyzed, identifying the groups of patients that are most favored with their indication. Also, despite the clear recommendations of the different guidelines, the reasons why their use in the usual practice is deficient are described.