1. Cardiac disease: Statins especially Atorvastatin in a dose of 20 mg, or Simvastatin in a dose of 40 mg should be used for every patient having ischaemic heart disease, whether he is on drugs or has had an angioplasty or by-pass surgery. Once the diagnosis is made, the patient needs to take statins lifetime. Not only that any person, male or female, above the age of 50, who has a bad family history, or who has other risk factors should be put on statins permanently.
2. Cerebro-vascular disease: Any patient (i) having an attack of TIA or ii)who has recovered from hemiplegia due to stroke or (iii) during routine health check up doppler study of carotid has shown some block, should be put on statins permanently.
3. Kidney disease: A patient of nephrotic syndrome should be prescribed statin permanently.
4. Hyperlipidaemia: Patients having hyperlipidaemia especially high LDL cholesterol at any age need statin prescription.
5. Osteoporosis: Women having osteoporosis benefit from statins, which should be started at the earliest specially if one of the indications mentioned above is present.
6. CRF: Nowadays in all patients of CRF statins are prescribed.

Statins should no more be considered as therapy for high cholesterol only because in hundreds of studies, its antiatherogenic effect has been convincingly shown, irrespective of the level of lipids. I must have used statins in thousands of patients. I have not seen a single case of severe rhabdomyositis with severe myoglobinuria, which is like seeing a rare case of anaphylatic shock occurring after penicillin injection. In such a case the drug has to be stopped immediately.

I have seen pelvic myopathy only in about a dozen patients where the drug had to be stopped. Muscle aches, muscle pains, occasional cramps and often slightly raised CPK levels or slightly altered liver function tests, are off and on seen and do not always call for stopping statins.

The only unfortunate part of the prescription is that poor patients have to bear the extra cost of the drug lifetime, while in countries like UK, they are planning to give this drug free to everybody, who is above the age of 50. A slightly raised incidence of lymphomas in patients, who are on statins according to me is not worth considering.

Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.