Source: Wikipedia. Pages: 28. Chapters: Atorvastatin, Atorvastatin/amlodipine, Cerivastatin, Cholesterol depletion, Discovery and development of statins, Fluvastatin, Iatrogenic hypocholesterolemia, Ibrolipim, Lovastatin, Mevastatin, Pitavastatin, Pravastatin, Rosuvastatin, Scandinavian Simvastatin Survival Study, Simvastatin/sitagliptin. Excerpt: Statins (or HMG-CoA reductase inhibitors) are a class of drugs used to lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver. Increased cholesterol levels have been associated with cardiovascular diseases, and statins are therefore used in the prevention of these diseases. Research has found that statins are most effective for treating cardiovascular disease (CVD) (secondary prevention), with questionable benefit in those without previous CVD, but with elevated cholesterol levels. Statins have rare but severe adverse effects, particularly muscle damage, and some doctors believe they are overprescribed. The best-selling statin is atorvastatin, marketed as Lipitor (manufactured by Pfizer) and Torvast. By 2003, atorvastatin became the best-selling pharmaceutical in history, with Pfizer reporting sales of US$12.4 billion in 2008. As of 2010, a number of statins are on the market: atorvastatin (Lipitor and Torvast), fluvastatin (Lescol), lovastatin (Mevacor, Altocor, Altoprev), pitavastatin (Livalo, Pitava), pravastatin (Pravachol, Selektine, Lipostat), rosuvastatin (Crestor) and simvastatin (Zocor, Lipex). Several combination preparations of a statin and another agent, such as ezetimibe/simvastatin, are also available. Clinical practice guidelines generally recommend people to try "lifestyle modification", including a cholesterol-lowering diet and physical exercise, before statin use is considered; statins or other pharmacologic agents may then be recommended for those who do not meet their lipid-lowering goals through diet and lifestyle approaches. There is debate over whether or not statins are effective in those with high cholesterol, but no other health problems. One review did not find a mortality benefit in those at high risk but without prior cardiovascular disease. Other reviews concluded there is a mortality and morbidity benefit, but there were concerns regarding the qualit