Editing Statin (section)

===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>