Three aspects of statin drugs can be compared: efficacy (by how much is my LDL cholesterol reduced?), safety (what are the side effects and how frequently do they occur?) and price.
Solid scientific data exists on the effect of different statins on lowering LDL cholesterol (standard doses common in drugs are shaded):
Lowering of LDL-Cholesterol by Statins (in %)
|Statin||Name Of Drug|
Daily Dose of Drug
There is a catch - the percentage of lowered LDL cholesterol as calculated above cannot be translated 1 to 1 into a decreased risk of heart disease or premature death. The reason is because statins seem to have additional positive effects in preventing atherosclerosis, apart from the benefit conferred by lower cholesterol levels.
This may include an improved functioning of artery walls and a positive influence on inflammation, a decrease in thrombus formation and enhanced plaque stability. There is currently insufficient data regarding whether different statins vary in these secondary effects. As a result, the actual risk reduction for heart disease and atherosclerosis might differ slightly from the values in the above table. You can obtain more concrete numbers regarding how much cholesterol reduction alone using any drug decreases heart attack rates by visiting here.
All statins on the market have a comparable safety profile. The rate of the most serious side effect, rhabdomolysis or a breakdown of muscle tissue which may lead to kidney failure in severe cases, is low. Fewer than 1 in 10,000 patients treated with statins experience rhabdomolysis.
There are slight differences when it comes to other rare side effects such as insomnia where pravastatin, fluvastatin and rosuvastatin might be superior to atorvastatin, lovastatin and simvastatin. The latter are more fat-soluble, and therefore more likely to cross the blood-brain-barrier and influence brain metabolism, including sleep patterns.
Atorvastatin and fluvastatin may be best for individuals with renal impairment, since the elimination of these two statins does not depend on the kidneys. This makes dose adjustments unnecessary, whereas the dose of pravastatin must be adjusted in patients with renal impairment.
There are also differences in the biochemical pathways the liver uses to metabolize various statins. The pathways that are also used by many other drugs can get clogged, which may cause an accumulation of drugs which and ultimately a toxic reaction. Fluvastatin, and particularly pravastatin have the least amount of interactions with other drugs and should be chosen for individuals who take a lot of other medications.
Chong and colleagues have developed 4 simple criteria for choosing the optimal statin:
- If LDL cholesterol reduction over 35% is required, consider atorvastatin, rosuvastatin or simvastatin
- If less than 35% reduction of LDL cholesterol is required and
- renal function is impaired, consider atorvastatin or fluvastatin
- risk for drug interactions is high, consider fluvastatin or pravastatin
Lovastatin and simvastatin are available as generics and are therefore cheapest. If you don't need to significantly lower your LDL cholesterol (atorvastatin and rosuvastatin may be tried if this is the case), generic statins may be the best option. In fact, health insurers have pressured patients to switch to simvastatin since it went off-patent in June 2006 in the US. In Britain, where simvastatin is available without a prescription, generic versions have been available since 2003. A useful fact sheet on statins from heartuk.org can be found here.