Statins: An Update on Clinical Issues and Selected Adverse Effects

• Newly released lipid guidelines are expected to increase statin prescribing.
• Benefits afforded by statin use generally outweigh the risk of diabetes.
• A direct association between statin use and cognitive function has not been proven.
• Data on acute kidney injury from statins is contradictory and at most a rare event.
• Adverse effect monitoring in patients initiated on statins should be individualized.

Statins are among the most extensively studied and commonly prescribed drugs in the United States. In November 2013, new clinical practice guidelines on lipid management were released that emphasized the use of fixed dosages of statins in patients at moderate and high risk of atherosclerotic cardiovascular disease. These new recommendations have decreased the emphasis on the use of nonstatin drugs and routine laboratory monitoring of lipid levels and hepatic transaminases. Although some adverse effects are well-known, statin-induced diabetes, cognitive changes, and acute kidney injury are controversial.