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HMG-CoA reductase inhibitors (statins) are lipid-lowering medications used in the primary and secondary prevention of coronary heart disease. This activity reviews the indications, contraindications, and mechanism of action of statins for the management of coronary heart disease and familial dyslipidemias. This activity will cover the indications, contraindications, activity, adverse events, and other critical elements of statin therapy, and highlight the crucial role of the interprofessional team in the management of patients with clinically significant atherosclerotic cardiovascular disease or individuals with risk factors for heart disease who can benefit from statin therapy. Objectives: Describe the indications for HMG-CoA reductase inhibitors (statins). Identify potential adverse events and contraindications to statin use. Outline the appropriate follow-up and monitoring of statins. Review interprofessional team strategies for improving care coordination and communication to enhance patient adherence to statin medications. Access free multiple choice questions on this topic.

The most common presentation of statin overdose is muscle toxicity. In case of severe muscle symptoms or rhabdomyolysis, statins therapy should stop immediately, and patients require symptomatic care. This care includes adequate fluid resuscitation, monitoring urine output, and correcting electrolyte imbalances, especially hyperkalemia. There is no antidote available for statin overdose. After the recovery from an overdose, patients should restart on low-dose statins.

Statins play an essential role in lowering the plasma concentrations of atherogenic lipids and in the prevention of clinical ASCVD. It is vital for healthcare professionals to educate patients about the benefits of statins and the importance of medication adherence. Additionally, patients need education about the side effects of statins to help improve their adherence to medication. Clinicians (MDs, DOs, NPs, PAs) will prescribe these drugs and decide both which agent as well as the dose based on the patient's lipid status. Nurses will often offer initial counseling to the patient as they start statin therapy, and can be the first line on monitoring treatment success, medication adherence, and the presence of adverse medication effects.  Pharmacist involvement comes in the form of verifying the agent selected, checking the dose, and performing medication reconciliation, as well as counseling on optimal administration and monitoring for adverse events. In both cases, nurses and pharmacists should report any concerns they encounter to the rest of the healthcare team. The medical personnel, including the physicians, specialists, nurse practitioners, specialty-trained nurses, and pharmacists, should all work collaboratively as an interprofessional team when administering statin therapy. All parties must be aware of the drug interactions and take a proper medication history before initiating statins. [Level V]