Intended for healthcare professionals

Practice Practical prescribing


51app 2024; 384 doi: (Published 24 January 2024) Cite this as: 51app 2024;384:e072584
  1. Spoorthy Kulkarni, post CCT fellow in clinical pharmacology and therapeutics1,
  2. Michaela M Watts, senior research sister in cardiovascular trials12,
  3. Michalis Kostapanos, consultant in acute and general internal medicine with subspecialty expertise in cardiovascular risk management12
  1. 1Clinical Pharmacology Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
  2. 2Lipid clinic, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust
  1. Correspondence to: M Kostapanos m.kostapanos{at}nhs.net

What you need to know

  • Statins are the first choice of therapy for hypercholesterolaemia and/or mixed dyslipidaemia for people with a moderate to high risk of cardiovascular disease

  • Evaluate cardiovascular disease risk for each patient and set individualised goals for serum levels of low density lipoprotein cholesterol

  • With shared decision making, select the appropriate statin intensity for treatment

  • Monitor safety and tolerability, as well as response to treatment, and escalate statin treatment as tolerated

Practical Prescribing is a series produced in conjunction with the Drug and Therapeutics Bulletin to highlight important issues for prescribers to consider and prompts for shared decision making between prescribers, patients, and their carers. Targeted at all medical and non-medical prescribers, particularly doctors in training, the series covers medicines commonly prescribed in primary and secondary care.

A 55 year old man without significant past medical history and who was not taking any regular medications has a transient ischaemic attack. His fasting lipid profile is total cholesterol 6.8 mmol/L (normal range <5 mmol/L), triglycerides 2.0 mmol/L (<1.7 mmol/L), high density lipoprotein cholesterol (HDL-C) 1.2 mmol/L (>1 mmol/L), low density lipoprotein cholesterol 4.6 mmol/L (<3.0 mmol/L), non-HDL-C 5.6 mmol/L (<4.0 mmol/L), and total-to-HDL cholesterol ratio 5.6 (<6). You are planning to discuss with the potential benefits and harms of treatment with a statin with him.

How often are statins prescribed and how do they work?

In 2018, across 83 countries covering 74% of the estimated global population, over 145 million people (2.6%) were taking a statin.1 In the UK, around 7.5 million (11.2%) people are prescribed a statin, with atorvastatin, simvastatin, and rosuvastatin being the most common. In England, over 80 million prescriptions for statins are dispensed at a cost of £116m yearly.2

Cardiovascular disease is the major contributor of mortality worldwide and accounts for approximately 30% of deaths globally.3 High cholesterol is one of the main modifiable risk factors for cardiovascular disease. Statins are efficacious in reducing serum levels …

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