<unk> s are usually used to lower blood cholesterol levels and reduce risk for illnesses related to atherosclerosis, with a varying degree of effect depending on underlying risk factors and history of cardiovascular disease. Clinical practice guidelines generally recommend people start with lifestyle modification through a cholesterol-lowering diet and physical exercise. For those unable to meet their lipid-lowering goals through such methods,<unk> s can be helpful. The medication appears to work equally well regardless of sex, although some sex-related differences in treatment response were described. If there is an underlying history of cardiovascular disease, it has a significant impact on the effects of<unk> . This can be used to divide medication usage into broad categories of primary and secondary prevention. Primary prevention For the primary prevention of cardiovascular disease, the United States Preventive Services Task Force (USPSTF) 2016 guidelines recommend<unk> s for those who have at least one risk factor for coronary heart disease, are between 40 and 75 years old, and have at least a 10% 10-year risk of heart disease, as calculated by the 2013 ACC/AHA Pooled Cohort algorithm. Risk factors for coronary heart disease included abnormal lipid levels in the blood, diabetes mellitus, high blood pressure, and smoking. They recommended selective use of low-to-moderate doses<unk> s in the same adults who have a calculated 10-year cardiovascular disease event risk of 7.5–10% or greater. In people over the age of 70,<unk> s decrease the risk of cardiovascular disease but only in those with a history of heavy cholesterol blockage in their arteries. Most evidence suggests that<unk> s are also effective in preventing heart disease in those with high cholesterol but no history of heart disease. A 2013 Cochrane review found a decrease in risk of death and other poor outcomes without any evidence of harm. For every 138 people treated for 5 years, one fewer dies; for every 49 treated, one fewer has an episode of heart disease. A 2011 review reached similar conclusions, and a 2012 review found benefits in both women and men. A 2010 review concluded that treatment without history of cardiovascular disease reduces cardiovascular events in men but not women, and provides no mortality benefit in either sex. Two other meta-analyses published that year, one of which used data obtained exclusively from women, found no mortality benefit in primary prevention. The National Institute for Health and Clinical Excellence (NICE) recommends<unk>  treatment for adults with an estimated 10 year risk of developing cardiovascular disease that is greater than 10%. Guidelines by the American College of Cardiology and the American Heart Association recommend<unk>  treatment for primary prevention of cardiovascular disease in adults with LDL cholesterol ≥ 190 mg/dL or those with diabetes, age 40–75 with LDL-C 70–190 mg/dl; or in those with a 10-year risk of developing heart attack or stroke of 7.5% or more. In this latter group,<unk>  assignment was not automatic, but was recommended to occur only after a clinician-patient risk discussion with shared decision making where other risk factors and lifestyle are addressed, the potential for benefit from a<unk>  is weighed against the potential for adverse effects or drug interactions and informed patient preference is elicited. Moreover, if a risk decision was uncertain, factors such as family history, coronary calcium score, ankle-brachial index, and an inflammation test (hs-CRP ≥ 2.0 mg/L) were suggested to inform the risk decision. Additional factors that could be used were an LDL-C ≥ 160 or a very high lifetime risk. However, critics such as Steven E. Nissen say that the AHA/ACC guidelines were not properly validated, overestimate the risk by at least 50%, and recommend<unk> s for people who will not benefit, based on populations whose observed risk is lower than predicted by the guidelines. The European Society of Cardiology and the European Atherosclerosis Society recommend the use of<unk> s for primary prevention, depending on baseline estimated cardiovascular score and LDL thresholds. Secondary prevention<unk> s are effective in decreasing mortality in people with pre-existing cardiovascular disease. Pre-existing disease can have many manifestations. Defining illnesses include a prior heart attack, stroke, stable or unstable angina, aortic aneurysm, or other arterial ischemic disease, in the presence of atherosclerosis. They are also advocated for use in people at high risk of developing coronary heart disease. On average,<unk> s can lower LDL cholesterol by 1.8 mmol/L (70 mg/dL), which translates into an estimated 60% decrease in the number of cardiac events (heart attack, sudden cardiac death) and a 17% reduced risk of stroke after long-term treatment. A greater benefit is observed with high-intensity<unk>  therapy. They have less effect than the fibrates or niacin in reducing triglycerides and raising HDL-cholesterol ("good cholesterol"). No studies have examined the effect of<unk> s on cognition in patients with prior stroke. However, two large studies (HPS and PROSPER) that included people with vascular diseases reported that simvastatin and pravastatin did not impact cognition.<unk> s have been studied for improving operative outcomes in cardiac and vascular surgery. Mortality and adverse cardiovascular events were reduced in<unk>  groups. Older adults who receive<unk>  therapy at time of discharge from the hospital after an inpatient stay have been studied. People with cardiac ischemia not previously on<unk> s at the time of admission have a lower risk of major cardiac adverse events and hospital readmission two years post-hospitalization. Comparative effectiveness While no direct comparison exists, all<unk> s appear effective regardless of potency or degree of cholesterol reduction. Simvastatin and pravastatin appear to have a reduced incidence of side-effects. A comparison of simvastatin, pravastatin, and atorvastatin, based on their effectiveness against placebos, found no differences in reduction of cardiovascular disease or lipid levels in the blood. A 2015 Cochrane systematic review update reported that rosuvastatin is more than three-fold more potent than atorvastatin. Females According to the 2015 Cochrane systematic review, atorvastatin showed greater cholesterol-lowering effect in females than in males compared to rosuvastatin. Children In children<unk> s are effective at reducing cholesterol levels in those with familial hypercholesterolemia. Their long term safety is, however, unclear. Some recommend that if lifestyle changes are not enough<unk> s should be started at 8 years old. Familial hypercholesterolemia<unk> s may be less effective in reducing LDL cholesterol in people with familial hypercholesterolemia, especially those with homozygous deficiencies. These people have defects usually in either the LDL receptor or apolipoprotein B genes, both of which are responsible for LDL clearance from the blood.<unk> s remain a first-line treatment in familial hypercholesterolemia, although other cholesterol-reducing measures may be required. In people with homozygous deficiencies,<unk> s may still prove helpful, albeit at high doses and in combination with other cholesterol-reducing medications. Contrast-induced nephropathy A 2014 meta-analysis found that<unk> s could reduce the risk of contrast-induced nephropathy by 53% in people undergoing coronary angiography/percutaneous interventions. The effect was found to be stronger among those with preexisting kidney dysfunction or diabetes mellitus.
Statin
Anisatin
Arbekacin
Pitavastatin
Cortistatin 
Petroleum jelly
Anthopleurin
Clitoraid