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Hypercholesterolemia, also known as high blood cholesterol, is a common risk factor for cardiovascular events due to atherosclerosis. It is mostly associated with family history, smoking, obesity and poor diets. Hypercholesterolemia is asymptomatic and can only be diagnosed by blood test. As an adjunct to diet, oral medications may be used to reduce the elevated levels of blood cholesterol.

HMG CoA reductase inhibitors (Statins)
Statins are the mainstay of adjunctive therapy of hypercholesterolemia. The choice of statins is based on the target of reduction in blood cholesterol.

Low-intensity statin (e.g. Simvastatin) is commonly used in people with normal or slightly elevated levels of blood cholesterol. It has a short duration of action and should be taken at night when most cholesterol is synthesized. Moderate or high intensity statins (e.g. Atorvastatin, Rosuvastatin) may also be considered if low-intensity statin is inadequate. Atorvastatin and Rosuvastatin can be taken at any time of day.

The most common side effect of statins is muscle pain. Simvastatin and Atorvastatin are CYP3A4 substrates which can interact with certain drugs and grapefruit, increasing the risk of muscle pain. Patients should be reminded to inform healthcare professionals whether they are taking other medications and have experienced muscle pain irrelevant to exercise.