The following table compares the side-effects of drugs used in hyperlipidaemia:

Drugs Mechanism of action Adverse effects
Statins HMG CoA reductase inhibitors Myositis, deranged LFTs
Ezetimibe Decreases cholesterol absorption in the small intestine by inhibiting NPC1L1 (Niemann-Pick 1 like 1) transmembrane protein Headache
Nicotinic acid Decreases hepatic VLDL secretion Flushing, myositis
Fibrates Agonist of PPAR-alpha therefore increases lipoprotein lipase expression Myositis, pruritus, cholestasis
Cholestyramine Decreases bile acid reabsorption in the small intestine, upregulating the amount of cholesterol that is converted to bile acid GI side-effects

Statins

Statins enhance hepatic LDL receptor recycling and increased LDL clearance form the circulation

The statins have a greater effect on lowering mortality compared with the other lipid lowering agents.

All patients with CVD should be taking a statin in the absence of any contraindication.

Atorvastatin 80mg should be offered first-line.

Note the downstream synthesis of CoQ which is important for electron transport chain. Once you inhibits HMG CoA reductase, it interferes with CoQ synthesis --> mitochondrial energy production --> muscle pain (myositis and myopathy)

So, consider adding CoQ10 supplement when giving Statins.

Follow-up of people started on statins

NICE recommend we follow-up patients at 3 months