Editing Statin (section)

==Medical uses==
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 [[Framingham Risk Score|risk factors]] and history of cardiovascular disease.<ref name=":4">{{Cite journal |last1=Tunnicliffe |first1=David J. |last2=Palmer |first2=Suetonia C. |last3=Cashmore |first3=Brydee A. |last4=Saglimbene |first4=Valeria M. |last5=Krishnasamy |first5=Rathika |last6=Lambert |first6=Kelly |last7=Johnson |first7=David W. |last8=Craig |first8=Jonathan C. |last9=Strippoli |first9=Giovanni Fm |date=29 November 2023 |title=HMG CoA reductase inhibitors (statins) for people with chronic kidney disease not requiring dialysis |journal=[[Cochrane Library|The Cochrane Database of Systematic Reviews]] |volume=11 |issue=11 |pages=CD007784 |doi=10.1002/14651858.CD007784.pub3 |issn=1469-493X |pmc=10685396 |pmid=38018702 }}</ref> A 2022 systematic review found the [[absolute risk]] 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 [[study heterogeneity|heterogeneity]] between trials.<ref>{{cite journal |vauthors=Byrne P, Demasi M, Jones M, Smith SM, O'Brien KK, DuBroff R |title=Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment: A Systematic Review and Meta-analysis |journal=[[JAMA Internal Medicine]] |volume=182 | issue=5 |pages=474–481 |date=May 2022 |pmid=35285850 |pmc=8922205 |doi=10.1001/jamainternmed.2022.0134 | doi-access=free}}</ref> [[Clinical practice guidelines]] generally recommend that people at low risk start with lifestyle modification through a cholesterol-lowering diet and [[physical exercise]]; for those unable to meet their lipid-lowering goals through such methods, statins can be helpful.<ref name="ATPIII">{{cite book |author=National Cholesterol Education Program |title=Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III): Executive Summary |publisher=[[National Institutes of Health]]. [[National Heart, Lung, and Blood Institute]] |year=2001 |location=Bethesda, MD |page=40 |id=NIH Publication No. 01-3670}}</ref><ref name="NICE">{{cite book | author=National Collaborating Centre for Primary Care | title=NICE clinical guideline 67: Lipid modification | location=London | publisher=National Institute for Health and Clinical Excellence | year=2010 | page=38 | url=http://www.nice.org.uk/nicemedia/live/11982/40689/40689.pdf | archive-url=https://web.archive.org/web/20101010200351/http://www.nice.org.uk/nicemedia/live/11982/40689/40689.pdf | archive-date=10 October 2010 | df=dmy-all }}</ref> The medication appears to work equally well regardless of sex,<ref>{{cite journal |author-link9=Rory Collins |vauthors=Fulcher J, O'Connell R, Voysey M, Emberson J, Blackwell L, Mihaylova B, Simes J, Collins R, Kirby A, Colhoun H, Braunwald E, La Rosa J, Pedersen TR, Tonkin A, Davis B, Sleight P, Franzosi MG, Baigent C, Keech A |date=April 2015 |title=Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials |journal=[[The Lancet]] |volume=385 |issue=9976 |pages=1397–1405 |doi=10.1016/s0140-6736(14)61368-4 |pmid=25579834 |s2cid=35330627 |hdl-access=free |hdl=2123/14127}}</ref> although some sex-related differences in treatment response were described.<ref>{{cite journal |vauthors=Cangemi R, Romiti GF, Campolongo G, Ruscio E, Sciomer S, Gianfrilli D, Raparelli V |date=March 2017 |title=Gender related differences in treatment and response to statins in primary and secondary cardiovascular prevention: The never-ending debate |journal=[[Pharmacological Research]] |volume=117 |pages=148–155 |doi=10.1016/j.phrs.2016.12.027 |pmid=28012963 |s2cid=32861954}}</ref>

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.<ref name="AHA 2018">{{cite journal |vauthors=Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC, Sperling L, Virani SS, Yeboah J |date=June 2019 |title=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 |journal=[[Journal of the American College of Cardiology]] |volume=73 |issue=24 |pages=e285–e350 |doi=10.1016/j.jacc.2018.11.003 |pmid=30423393 | doi-access = free | title-link = doi |hdl-access=free |hdl=20.500.12749/1738}}</ref>

===Primary prevention===
For the primary prevention of cardiovascular disease, the [[United States Preventive Services Task Force]] (USPSTF) 2016 guidelines recommend statins for those who have at least one risk factor for [[coronary heart disease]], 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.<ref name="AHA 2018"/><ref name=JAMA2016/><ref>{{cite web |title=ACC/AHA ASCVD Risk Calculator |url=http://www.cvriskcalculator.com/ |website=www.cvriskcalculator.com |access-date=8 March 2019 |archive-date=9 March 2019 |archive-url=https://web.archive.org/web/20190309213928/http://www.cvriskcalculator.com/ }}</ref> Risk factors for coronary heart disease included [[dyslipidemia|abnormal lipid levels in the blood]], [[diabetes mellitus]], [[high blood pressure]], and [[smoking]].<ref name=JAMA2016>{{cite journal | vauthors = Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW, García FA, Gillman MW, Kemper AR, Krist AH, Kurth AE, Landefeld CS, LeFevre ML, Mangione CM, Phillips WR, Owens DK, Phipps MG, Pignone MP | title = Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement | journal = JAMA | volume = 316 | issue = 19 | pages = 1997–2007 | date = November 2016 | pmid = 27838723 | doi = 10.1001/jama.2016.15450 | s2cid = 205075217 }}</ref> 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.<ref name=JAMA2016/> 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.<ref>{{cite journal | title = Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials | journal = Lancet | volume = 393 | issue = 10170 | pages = 407–415 | date = February 2019 | pmid = 30712900 | pmc = 6429627 | doi = 10.1016/S0140-6736(18)31942-1 | vauthors = Armitage J, Baigent C, Barnes E, Betteridge DJ, Blackwell L, Blazing M, Bowman L, Braunwald E, Byington R, Cannon C, Clearfield M, Colhoun H, Collins R, Dahlöf B, Davies K, Davis B, De Lemos J, Downs JR, Durrington P, Emberson J, Fellström B, Flather M, Ford I, Franzosi MG, Fulcher J, Fuller J, Furberg C, Gordon D, Goto S, Gotto A }}</ref>

Most evidence suggests that statins are also effective in preventing heart disease in those with [[hypercholesterolemia|high cholesterol]] but no history of heart disease. A 2013 [[Cochrane review]] found a decrease in risk of death and other poor outcomes without any evidence of harm.<ref name="Cochrane13"/> For every 138 people treated for 5 years, one fewer dies; for every 49 treated, one fewer has an episode of heart disease.<ref name=Taylor2013/> A 2011 review reached similar conclusions,<ref name="CMAJ11"/> and a 2012 review found benefits in both women and men.<ref>{{cite journal | vauthors = Kostis WJ, Cheng JQ, Dobrzynski JM, Cabrera J, Kostis JB | title = Meta-analysis of statin effects in women versus men | journal = Journal of the American College of Cardiology | volume = 59 | issue = 6 | pages = 572–582 | date = February 2012 | pmid = 22300691 | doi = 10.1016/j.jacc.2011.09.067 | doi-access = free | title-link = doi }}</ref> 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.<ref>{{cite journal | vauthors = Petretta M, Costanzo P, Perrone-Filardi P, Chiariello M | title = Impact of gender in primary prevention of coronary heart disease with statin therapy: a meta-analysis | journal = International Journal of Cardiology | volume = 138 | issue = 1 | pages = 25–31 | date = January 2010 | pmid = 18793814 | doi = 10.1016/j.ijcard.2008.08.001 }}</ref> Two other meta-analyses published that year, one of which used data obtained exclusively from women, found no mortality benefit in primary prevention.<ref>{{cite journal | vauthors = Ray KK, Seshasai SR, Erqou S, Sever P, Jukema JW, Ford I, Sattar N | title = Statins and all-cause mortality in high-risk primary prevention: a meta-analysis of 11 randomized controlled trials involving 65,229 participants | journal = Archives of Internal Medicine | volume = 170 | issue = 12 | pages = 1024–1031 | date = June 2010 | pmid = 20585067 | doi = 10.1001/archinternmed.2010.182 | doi-access = free | title-link = doi }}</ref><ref>{{cite journal | vauthors = Bukkapatnam RN, Gabler NB, Lewis WR | title = Statins for primary prevention of cardiovascular mortality in women: a systematic review and meta-analysis | journal = Preventive Cardiology | volume = 13 | issue = 2 | pages = 84–90 | year = 2010 | pmid = 20377811 | doi = 10.1111/j.1751-7141.2009.00059.x | doi-access = free | title-link = doi }}</ref>

The [[National Institute for Health and Clinical Excellence]] (NICE) recommends statin treatment for adults with an estimated 10 year risk of developing cardiovascular disease that is greater than 10%.<ref>{{cite web |url=http://www.nice.org.uk/guidance/cg181/chapter/1-recommendations |title=Cardiovascular disease: risk assessment and reduction, including lipid modification at www.nice.org.uk |date=18 July 2014 |access-date=1 May 2017 |archive-date=12 June 2018 |archive-url=https://web.archive.org/web/20180612162609/https://www.nice.org.uk/guidance/cg181/chapter/1-recommendations |url-status=live }}</ref> Guidelines by the [[American College of Cardiology]] and the [[American Heart Association]] recommend statin treatment for primary prevention of cardiovascular disease in adults with LDL cholesterol ≥ 190&nbsp;mg/dL (4.9&nbsp;mmol/L) or those with diabetes, age 40–75 with LDL-C 70–190&nbsp;mg/dL (1.8–4.9&nbsp;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, [[Ankle-brachial pressure index|ankle-brachial index]], and an inflammation test ([[C-reactive protein|hs-CRP]] ≥ 2.0&nbsp;mg/L) were suggested to inform the risk decision. Additional factors that could be used were an LDL-C ≥ 160&nbsp;mg/dL (4.14&nbsp;mmol/L) or a very high lifetime risk.<ref>{{cite journal | vauthors = Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero ST, Smith SC, Watson K, Wilson PW, Eddleman KM, Jarrett NM, LaBresh K, Nevo L, Wnek J, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Smith SC, Tomaselli GF | title = 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines | journal = Circulation | volume = 129 | issue = 25 Suppl 2 | pages = S1-45 | date = June 2014 | pmid = 24222016 | doi = 10.1161/01.cir.0000437738.63853.7a | author-link3 = Alice H. Lichtenstein | doi-access = free | title-link = doi }}</ref> 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.<ref name="Nissen2014">{{cite journal | vauthors = Nissen SE | title = Prevention guidelines: bad process, bad outcome | journal = JAMA Internal Medicine | volume = 174 | issue = 12 | pages = 1972–1973 | date = December 2014 | pmid = 25285604 | doi = 10.1001/jamainternmed.2014.3278 }}</ref> The [[European Society of Cardiology]] and the European Atherosclerosis Society recommend the use of statins for primary prevention, depending on baseline estimated cardiovascular score and LDL thresholds.<ref>{{cite journal | vauthors = Reiner Ž, Catapano AL, De Backer G, Graham I, Taskinen MR, Wiklund O, Agewall S, Alegría E, Chapman MJ, Durrington P, Erdine S, Halcox J, Hobbs RH, Kjekshus JK, Perrone Filardi P, Riccardi G, Storey RF, David W | title = [ESC/EAS Guidelines for the management of dyslipidaemias] | journal = Revista Espanola de Cardiologia | volume = 64 | issue = 12 | pages = 1168.e1–1168.e60 | date = December 2011 | pmid = 22115524 | doi = 10.1016/j.rec.2011.09.015 | hdl = 2268/205760 }}</ref>

===Secondary prevention===
Statins are effective in decreasing mortality in people with pre-existing [[cardiovascular disease]].<ref name="Collins2016" /> Pre-existing disease can have many manifestations. Defining illnesses include a prior heart attack, stroke, stable or unstable [[angina]], [[aortic aneurysm]], or other arterial [[ischemic]] disease, in the presence of atherosclerosis.<ref name="AHA 2018"/> They are also advocated for use in people at high risk of developing coronary heart disease.<ref name=NICEquick>{{cite web |author=National Institute for Health and Clinical Excellence |author-link=National Institute for Health and Clinical Excellence |title=Lipid modification – Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease – Quick reference guide |url=http://www.nice.org.uk/nicemedia/live/11982/40675/40675.pdf |archive-url=https://web.archive.org/web/20110408210750/http://www.nice.org.uk/nicemedia/live/11982/40675/40675.pdf |archive-date=8 April 2011 |orig-date=May 2008 |date=March 2010 |access-date=25 August 2010}}</ref> On average, statins can lower [[LDL cholesterol]] by 1.8&nbsp;mmol/L (70&nbsp;mg/dL), which translates into an estimated 60% decrease in the number of cardiac events (heart attack, [[sudden cardiac death]]) and a 17% reduced risk of [[stroke]] after long-term treatment.<ref>{{cite journal | vauthors = Law MR, Wald NJ, Rudnicka AR | title = Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis | journal = BMJ | volume = 326 | issue = 7404 | pages = 1423–0 | date = June 2003 | pmid = 12829554 | pmc = 162260 | doi = 10.1136/bmj.326.7404.1423 }}</ref> A greater benefit is observed with high-intensity statin therapy.<ref>{{cite journal | vauthors = Pisaniello AD, Scherer DJ, Kataoka Y, Nicholls SJ | title = Ongoing challenges for pharmacotherapy for dyslipidemia | journal = Expert Opinion on Pharmacotherapy | volume = 16 | issue = 3 | pages = 347–356 | date = February 2015 | pmid = 25476544 | doi = 10.1517/14656566.2014.986094 | s2cid = 539314 }}</ref> They have less effect than the [[fibrate]]s or [[Niacin (substance)|niacin]] in reducing [[triglyceride]]s and raising [[HDL-cholesterol]] ("good cholesterol").<ref name="Kushner2016">{{cite journal | vauthors = Kushner PA, Cobble ME | title = Hypertriglyceridemia: the importance of identifying patients at risk | journal = Postgraduate Medicine | volume = 128 | issue = 8 | pages = 848–858 | date = November 2016 | pmid = 27710158 | doi = 10.1080/00325481.2016.1243005 | type = Review | s2cid = 45663315 }}</ref><ref name="Khera2013">{{cite journal | vauthors = Khera AV, Plutzky J | title = Management of low levels of high-density lipoprotein-cholesterol | journal = Circulation | volume = 128 | issue = 1 | pages = 72–78 | date = July 2013 | pmid = 23817482 | pmc = 4231714 | doi = 10.1161/CIRCULATIONAHA.112.000443 | type = Review }}</ref>

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.<ref>{{cite journal | vauthors = Mijajlović MD, Pavlović A, Brainin M, Heiss WD, Quinn TJ, Ihle-Hansen HB, Hermann DM, Assayag EB, Richard E, Thiel A, Kliper E, Shin YI, Kim YH, Choi S, Jung S, Lee YB, Sinanović O, Levine DA, Schlesinger I, Mead G, Milošević V, Leys D, Hagberg G, Ursin MH, Teuschl Y, Prokopenko S, Mozheyko E, Bezdenezhnykh A, Matz K, Aleksić V, Muresanu D, Korczyn AD, Bornstein NM | title = Post-stroke dementia - a comprehensive review | journal = BMC Medicine | volume = 15 | issue = 1 | pages = 11 | date = January 2017 | pmid = 28095900 | pmc = 5241961 | doi = 10.1186/s12916-017-0779-7 | doi-access = free | title-link = doi }}</ref>

Statins have been studied for improving operative outcomes in cardiac and vascular surgery.<ref>{{cite journal | vauthors = de Waal BA, Buise MP, van Zundert AA | title = Perioperative statin therapy in patients at high risk for cardiovascular morbidity undergoing surgery: a review | journal = British Journal of Anaesthesia | volume = 114 | issue = 1 | pages = 44–52 | date = January 2015 | pmid = 25186819 | doi = 10.1093/bja/aeu295 | doi-access = free | title-link = doi }}</ref> Mortality and adverse cardiovascular events were reduced in statin groups.<ref>{{cite journal | vauthors = Antoniou GA, Hajibandeh S, Hajibandeh S, Vallabhaneni SR, Brennan JA, Torella F | title = Meta-analysis of the effects of statins on perioperative outcomes in vascular and endovascular surgery | journal = Journal of Vascular Surgery | volume = 61 | issue = 2 | pages = 519–532.e1 | date = February 2015 | pmid = 25498191 | doi = 10.1016/j.jvs.2014.10.021 | doi-access = free | title-link = doi }}</ref>

Older adults who receive statin therapy at time of discharge from the hospital after an [[inpatient]] 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.<ref>{{cite journal | vauthors = Sladojevic N, Yu B, Liao JK | title = ROCK as a therapeutic target for ischemic stroke | journal = Expert Review of Neurotherapeutics | volume = 17 | issue = 12 | pages = 1167–1177 | date = December 2017 | pmid = 29057688 | pmc = 6221831 | doi = 10.1080/14737175.2017.1395700 }}</ref><ref>{{cite journal | vauthors = Li YH, Ueng KC, Jeng JS, Charng MJ, Lin TH, Chien KL, Wang CY, Chao TH, Liu PY, Su CH, Chien SC, Liou CW, Tang SC, Lee CC, Yu TY, Chen JW, Wu CC, Yeh HI | title = 2017 Taiwan lipid guidelines for high risk patients | journal = Journal of the Formosan Medical Association = Taiwan Yi Zhi | volume = 116 | issue = 4 | pages = 217–248 | date = April 2017 | pmid = 28242176 | doi = 10.1016/j.jfma.2016.11.013 | doi-access = free | title-link = doi }}</ref>

===Statin product offerings - comparative effectiveness===
All statins appear effective regardless of potency or degree of cholesterol reduction.<ref name=CMAJ11>{{cite journal | vauthors = Tonelli M, Lloyd A, Clement F, Conly J, Husereau D, Hemmelgarn B, Klarenbach S, McAlister FA, Wiebe N, Manns B | title = Efficacy of statins for primary prevention in people at low cardiovascular risk: a meta-analysis | journal = CMAJ | volume = 183 | issue = 16 | pages = E1189–E1202 | date = November 2011 | pmid = 21989464 | pmc = 3216447 | doi = 10.1503/cmaj.101280 }}</ref><ref>{{Cite journal |last1=Sheng |first1=Xia |last2=Murphy |first2=Michael J. |last3=MacDonald |first3=Thomas M. |last4=Wei |first4=Li |date=30 August 2012 |title=The comparative effectiveness of statin therapy in selected chronic diseases compared with the remaining population |journal=BMC Public Health |volume=12 |issue=1 |pages=712 |doi=10.1186/1471-2458-12-712 |issn=1471-2458 |pmc=3490740 |pmid=22935195 | doi-access = free | title-link = doi }}</ref><ref>{{Cite web |title=Assessing Severity of Statin Side Effects: Fact Versus Fiction |url=https://www.acc.org/Latest-in-Cardiology/Articles/2018/04/09/13/25/http%3a%2f%2fwww.acc.org%2fLatest-in-Cardiology%2fArticles%2f2018%2f04%2f09%2f13%2f25%2fAssessing-Severity-of-Statin-Side-Effects |access-date=11 November 2023 |website=American College of Cardiology}}</ref> Simvastatin and pravastatin appear to have a reduced incidence of side-effects.<ref name=Naci2013/><ref>{{Citation |last1=Bansal |first1=Agam B. |title=HMG-CoA Reductase Inhibitors |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK542212/ |work=StatPearls |access-date=11 November 2023 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=31194369 |last2=Cassagnol |first2=Manouchkathe}}</ref><ref>{{Cite journal |last1=Zhang |first1=Xiaodan |last2=Xing |first2=Lu |last3=Jia |first3=Xiaona |last4=Pang |first4=Xiaocong |last5=Xiang |first5=Qian |last6=Zhao |first6=Xia |last7=Ma |first7=Lingyue |last8=Liu |first8=Zhiyan |last9=Hu |first9=Kun |last10=Wang |first10=Zhe |last11=Cui |first11=Yimin |date=27 April 2020 |title=Comparative Lipid-Lowering/Increasing Efficacy of 7 Statins in Patients with Dyslipidemia, Cardiovascular Diseases, or Diabetes Mellitus: Systematic Review and Network Meta-Analyses of 50 Randomized Controlled Trials |journal=Cardiovascular Therapeutics |volume=2020 |pages=e3987065 |doi=10.1155/2020/3987065 |issn=1755-5914| doi-access = free | title-link = doi |pmid=32411300 |pmc=7201823 }}</ref>

===Women and children===
According to the 2015 Cochrane systematic review, atorvastatin showed greater cholesterol-lowering effect in women than in men compared to rosuvastatin.<ref name="AdamsTsangWright2015">{{cite journal |vauthors=Adams SP, Tsang M, Wright JM |date=March 2015 |title=Lipid-lowering efficacy of atorvastatin |journal=The Cochrane Database of Systematic Reviews |volume=2015 |issue=3 |pages=CD008226 |doi=10.1002/14651858.CD008226.pub3 |pmc=6464917 |pmid=25760954}}</ref>

In children, statins are effective at reducing cholesterol levels in those with [[familial hypercholesterolemia]].<ref name=":0">{{cite journal | vauthors = Vuorio A, Kuoppala J, Kovanen PT, Humphries SE, Tonstad S, Wiegman A, Drogari E, Ramaswami U | title = Statins for children with familial hypercholesterolemia | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 11 | date = November 2019 | pmid = 31696945 | pmc = 6836374 | doi = 10.1002/14651858.CD006401.pub5 }}</ref> Their long term safety is, however, unclear.<ref name=":0" /><ref>{{cite journal | vauthors = Lamaida N, Capuano E, Pinto L, Capuano E, Capuano R, Capuano V | title = The safety of statins in children | journal = Acta Paediatrica | volume = 102 | issue = 9 | pages = 857–862 | date = September 2013 | pmid = 23631461 | doi = 10.1111/apa.12280 | s2cid = 22846175 }}</ref> Some recommend that if lifestyle changes are not enough statins should be started at 8 years old.<ref>{{cite journal | vauthors = Braamskamp MJ, Wijburg FA, Wiegman A | title = Drug therapy of hypercholesterolaemia in children and adolescents | journal = Drugs | volume = 72 | issue = 6 | pages = 759–772 | date = April 2012 | pmid = 22512364 | doi = 10.2165/11632810-000000000-00000 | s2cid = 21141894 }}</ref>

===Familial hypercholesterolemia===
Statins may be less effective in reducing LDL cholesterol in people with familial hypercholesterolemia, especially those with [[homozygous]] deficiencies.<ref name="Repas2014"/> These people have defects usually in either the [[LDL receptor]] or [[apolipoprotein B]] genes, both of which are responsible for LDL clearance from the blood.<ref>{{cite journal | vauthors = Ramasamy I | title = Update on the molecular biology of dyslipidemias | journal = Clinica Chimica Acta; International Journal of Clinical Chemistry | volume = 454 | pages = 143–185 | date = February 2016 | pmid = 26546829 | doi = 10.1016/j.cca.2015.10.033 }}</ref> Statins remain a first-line treatment in familial hypercholesterolemia,<ref name="Repas2014">{{cite journal | vauthors = Repas TB, Tanner JR | title = Preventing early cardiovascular death in patients with familial hypercholesterolemia | journal = The Journal of the American Osteopathic Association | volume = 114 | issue = 2 | pages = 99–108 | date = February 2014 | pmid = 24481802 | doi = 10.7556/jaoa.2014.023 | doi-access = free | title-link = doi }}</ref> although other cholesterol-reducing measures may be required.<ref name="Rader2003">{{cite journal | vauthors = Rader DJ, Cohen J, Hobbs HH | title = Monogenic hypercholesterolemia: new insights in pathogenesis and treatment | journal = The Journal of Clinical Investigation | volume = 111 | issue = 12 | pages = 1795–1803 | date = June 2003 | pmid = 12813012 | pmc = 161432 | doi = 10.1172/JCI18925 }}</ref> In people with homozygous deficiencies, statins may still prove helpful, albeit at high doses and in combination with other cholesterol-reducing medications.<ref>{{cite journal | vauthors = Marais AD, Blom DJ, Firth JC | title = Statins in homozygous familial hypercholesterolemia | journal = Current Atherosclerosis Reports | volume = 4 | issue = 1 | pages = 19–25 | date = January 2002 | pmid = 11772418 | doi = 10.1007/s11883-002-0058-7 | s2cid = 8075552 }}</ref>

===Contrast-induced nephropathy===
A 2014 [[meta-analysis]] found that statins could reduce the risk of [[contrast-induced nephropathy]] by 53% in people undergoing [[coronary catheterization|coronary angiography]]/percutaneous interventions. The effect was found to be stronger among those with preexisting kidney dysfunction or diabetes mellitus.<ref>{{cite journal | vauthors = Liu YH, Liu Y, Duan CY, Tan N, Chen JY, Zhou YL, Li LW, He PC | title = Statins for the Prevention of Contrast-Induced Nephropathy After Coronary Angiography/Percutaneous Interventions: A Meta-analysis of Randomized Controlled Trials | journal = Journal of Cardiovascular Pharmacology and Therapeutics | volume = 20 | issue = 2 | pages = 181–192 | date = March 2015 | pmid = 25193735 | doi = 10.1177/1074248414549462 | s2cid = 28251228 | doi-access = free | title-link = doi }}</ref>

=== Chronic kidney disease ===
The risk of cardiovascular disease is similar in people with chronic kidney disease and coronary artery disease and statins are often suggested.<ref name=":4" /> 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.<ref name=":4" />

'''<big>Asthma</big>'''

Statins have been identified as having a possible adjunct role in the treatment of asthma through anti-inflammatory pathways.<ref name=":3">{{cite journal | vauthors = Naing C, Ni H | title = Statins for asthma | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | issue = 7 | pages = CD013268 | date = July 2020 | pmid = 32668027 | pmc = 7388183 | doi = 10.1002/14651858.CD013268.pub2 | collaboration = Cochrane Airways Group }}</ref> 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.<ref name=":3" />