How to balance cardiorenometabolic benefits and risks of statins

Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Nephrology

Background:

• Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are crucial for cardiovascular event prevention by lowering LDL cholesterol.
• Statin use is linked to adverse effects, including impaired glucose homeostasis, increased diabetes risk, and potential dose-dependent renal insult.
• Recent guidelines recommend broader statin use, raising concerns about long-term side effects in diverse populations, including Asians.

Purpose of the Study:

• To investigate the complex balance between the cardiovascular benefits and potential renometabolic risks of statin therapy.
• To highlight the need for personalized therapeutic strategies considering individual vulnerability to statin-induced side effects.
• To emphasize the importance of understanding statin metabolism and off-target effects for optimizing patient outcomes.

Main Methods:

• Review of existing literature on statin efficacy and adverse effects.
• Analysis of dose-dependent relationships between statin treatment and renometabolic outcomes.
• Discussion of the potential role of genetic and pharmacogenetic approaches in risk stratification.

Main Results:

• Statins offer significant cardiovascular protection across various risk groups.
• Statin therapy is associated with dose-dependent risks of diabetes mellitus and potential renal injury.
• Current evidence suggests a need to re-evaluate the risk-benefit profile of widespread, long-term statin use, especially in specific ethnic groups.

Conclusions:

• Balancing statin's cardiovascular benefits against renometabolic risks requires further investigation.
• Pharmacogenetic strategies are essential to identify individuals susceptible to adverse effects like diabetes mellitus and acute kidney injury.
• Optimizing statin therapy necessitates a deeper understanding of its metabolism and off-target actions to reduce overall morbidity and mortality.