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Simvastatin is a powerful lipid-lowering drug that can decrease low density lipoprotein (LDL) levels by up to 50%. It is used in doses of 10 mg up to 80 mg. Higher doses (160 mg) have been found to be too toxic, while giving only minimal benefit in terms of lipid lowering. There is no real effect on HDL and triglyceride levels.
From recent research it has become apparent that simvastatin and other statins inhibit the progression of atherosclerosis beyond their effects on LDL. A large number of explanations has been proposed, for example its inhibitory effect on macrophages in the atherosclerotic plaque lesions.
Since its introduction, there has been a large debate surrounding the price for lipid-lowering treatment and its benefits on atherosclerosis. Although this has affected the other statins as well, simvastatin was the first statin drug to be used extensively in clinical practice.
A number of large epidemiological studies were conducted to discover which patients would benefit most from statin drugs; most studies involve simvastatin as the study drug. The most influential studies were the Scandinavian Simvastatin Survival Study (4S) and the Heart protection study (HPS).
It has now become apparent that patients with one or more risk factors for cardiovascular disease (such as diabetes mellitusThis article is about the disease that features high blood sugar. The other major but far less common diabetes is diabetes insipidus ("water diabetes", DI). Diabetes mellitus is a medical disorder characterized by varying or persistent hyperglycemia (elev, hypertensionIn medicine, hypertension refers to the problem of abnormally high blood pressure. There are three main types of hypertension, namely: # arterial hypertension with an elevated blood pressure in the systemic circulation # pregnancy-induced hypertension is or a positive family history) can benefit from statins—even if their cholesterol is not substantially increased.
Simvastatin was introduced in the late 1980sMillennia: 1st millennium 2nd millennium 3rd millennium Centuries: 19th century 20th century 21st century Decades: 1930s 1940s 1950s 1960s 1970s 1980s 1990s 2000s 2010s 2020s 2030s Years: 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 Events and trends, and in many countries it is now available as a generic preparation. This has led to a decrease of the price of most statin drugs, and a reappraisal of the health economics of preventive statin treatment.
In the UK, simvastatin (in a dose of 10mg) has recently become available to purchase from pharmacies without prescription.
See statin for more details
All statins act by inhibiting HMG-CoA reductase, the rate-limiting enzyme of the HMG-CoA reductase pathwayThe HMG-CoA reductase pathway is an important cellular metabolic pathway present in virtually all organisms. It forms hydrophobic molecules for tasks as diverse as cell membrane maintenance, hormones, protein anchoring and N glycosylation. Reactions Acety, the metabolic pathwayIn biochemistry, a metabolic pathway is a series of chemical reactions occurring within a cell, catalyzed by enzymes, and resulting in either the formation of a metabolic product to be used or stored by the cell ( metabolic sink), or the initiation of ano responsible for the innate production of cholesterol.