A diagnosis of high cholesterol can be intimidating, but there is a lot you can do to control this condition. In addition to modifying your diet and upping your exercise, the addition of a HMG-CoA Reductase Inhibitor — a class of drugs commonly called “statins” — can safely and effectively lower your cholesterol. (HMG-CoA Reductase helps our liver produce cholesterol; when the chemical is inhibited, the amount of cholesterol is correspondingly reduced.) For people with heart disease, statins can lower the risk of a cardiac event and subsequent death. If you and your doctor have determined that you need a statin, how can you pick the right statin for your needs?
There are six statins on the market: atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin. They differ in their ability to reduce cholesterol, and they also differ in their rates of reducing heart attacks. Their costs are also quite different — and since most people take statins for a long time, the costs add up over the years. With all of these variables, choosing the right statin for you can be complex.
All statins are capable of lowering LDL (“bad”) cholesterol and triglycerides, and raising HDL (“good”) cholesterol. The statins do differ in how effectively they can do this, and it is highly dose-dependent. Says Drug Digest:
If the needed LDL-C reduction is up to 35-36%, any of the statins should be acceptable choices for therapy. For a desired reduction of LDL-C greater than 42%, simvastatin (Zocor), atorvastatin (Lipitor), or rosuvastatin (Crestor) would be needed.
Indeed, the best-known statins are Crestor, Lipitor, and Zocor (quite probably because they have the greatest effect on cholesterol levels). The latter two are also endorsed by Consumer Reports. Taking evidence for effectiveness, safety, and cost into account, the publication rated both of these statins as “Consumer Reports Best Buy Drugs.” They recommend:
• Generic simvastatin (20mg or 40 mg) — if you need 30% or greater LDL reduction and/or have heart disease or diabetes, or if you have had a heart attack or have acute coronary syndrome and your LDL level is not highly elevated.
• Atorvastatin (Lipitor) (40mg or 80mg) — if you have had a heart attack or have acute coronary syndrome and your LDL is highly elevated; use for two years and then reconfirm need or switch to generic simvastatin.
Charts on Drug Digest have some great comparisons. For instance, they show that Lipitor (10-80 mg.) can reduce total cholesterol by 25-45%, while Zocor (5-80 mg.) can reduce the same numbers by 19-36%, and Crestor (5-40 mg.) can reduce it by 33-46%. As for lowering HDL, Lipitor can offer reduction of 5-9%, Zocor lessens HDL by 8-16%, and Crestor lowers these numbers by 8-14%. As you can see, choosing the proper statin has a lot to do with which numbers (Total Cholesterol, HDL, LDL, or triglycerides) you are trying to effect.
A final consideration is that last year there was reporting on an observational study done by Pfizer that suggested that there were certain benefits to using Lipitor over Crestor. However, one must keep in mind that Pfizer conducted the study, and they are the manufacturer of Lipitor, and they are defending this drug against Merck’s Zocor product, which is now available in a generic formula. Here is the information as presented by The Wall Street Journal:
An analysis, published in the latest Clinical Therapeutics Journal, mined a large database of health-care records and found that patients taking Lipitor had a 12% lower risk of a cardiovascular event than those on simvastatin, the generic name for Zocor. The patients on Lipitor had a 15% lower risk of having a heart attack.
So-called observational studies like this one that look at data after the fact aren’t as powerful as prospective clinical trials. Jack Tu, a cardiologist who specializes in outcomes research at Canada’s Institute for Clinical Evaluative Sciences, says the latest Pfizer study didn’t take into account factors that could predispose a patient to heart problems, such as smoking and cholesterol levels. “Just on this alone, you wouldn’t recommend that everyone should switch onto Lipitor,” he says.
Still, Pfizer hopes that doctors will take notice. “We’ve done two rather large observational studies and patients have a lower risk of cardiovascular events on Lipitor [compared with] simvastatin,” says Susan Shiff, Pfizer’s team leader for cardiovascular outcomes. “Doctors need to factor this into discussions with patients.”
You should definitely discuss with your physician which statin is right for you. In general, the best plan is to take the LOWEST dose of a statin that gets you to your target level for cholesterol. Overly large doses can be harmful to your liver and to your muscles. If you experience muscle aches and pains when taking a statin, contact your doctor immediately.
14 responses so far ↓
1 R. Bodnar // Sep 21, 2009 at 4:49 pm
Did the DRUG DIGEST really mean to say these statins LOWER HDL?
Aren’t they supposed to LOWER LDL and possibly RAISE HDL???
2 Ernie Smith // Oct 5, 2009 at 10:27 am
I am currently taking Crestor which my doctor lowered from 10mg to 5mg. When I tried to fill the new prescription of 5mg Crestor, the insurance company refused to pay for it. They said I should change to another statin drug that is available in generic form (apparently Crestor isn’t). The pharmacy filled my prescription using Zocor 20mg. I’ve tried these type of drugs before like Lopid and Lipitor but they caused muscle problems. The Crestor worked very well for me without these side effects. Is it safe to switch to Zocor 20mg and can it cause these adverse side effects?
Thanks
Ernie
3 Ghorm // Oct 19, 2009 at 9:15 am
for the HDL , it increase not decrease as mentioned here :
(As for lowering HDL, Lipitor can offer reduction of 5-9%, Zocor lessens HDL by 8-16%, and Crestor lowers these numbers by 8-14%. )
4 Trevor // Oct 28, 2009 at 12:38 pm
While I assume that was a mistake, they should help raise HDL as lowering HDL is undesired, I have had that experience. I was 280 total and 33 HDL before Lipitor 20 mg. After 1 month of lipitor 20mg, I am 165 total and 20 HDL. While 165 is great, 20 is horrible. How do I go from 33 to 20 HDL in one month???
5 Steve // Oct 30, 2009 at 8:33 am
According to the Drug Digest article referenced, all of the drugs raise HDL (as you would expect). So when the above says “As for lowering HDL .. .reduction … lessens … lowers …” they got it exactly backwards. Reckless writing about an important subject.
6 tina // Dec 16, 2009 at 3:32 pm
I have been on Crestor for 5 weeks, the past two weeks i have been experiencing back muscel pain. it isnt going away. i am wondering if it has anything to do with Crestor, should i change to Lipitor?
7 Ann // Dec 16, 2009 at 8:06 pm
What about Niacin for lowering Cholesterol?
8 David // Dec 18, 2009 at 9:40 pm
I was on Lipitor and began having major body pains in the shoulder and lower back and lesions on my legs. My doctor sent me to physical therapy and dermatologist. Got so bad I had to sleep sitting up. Anyway, my Lipitor ran out and I didn’t refill and guess what, my pain started to lessen and the lesion started to heal up. Did some research and discovered some studies that suggest that statin builds up and doesn’t eliminate (flush out) from people of Asian descedent and can cause these problems. I am now on Zocor and when the pain starts to flare up, I just either take half dosage or take it every other day. Follow up blood test did not show any reduction in the effectiviness of reducing my cholesterol levels. So speak with your doctor about this. Switching from one statin to another one won’t change the body pain in my opinion. For me it was giving my body a chance to get rid of the build up until I was comfortable again. Hope this helps.
9 David // Dec 18, 2009 at 9:52 pm
Follow up comment: My doctor switched me to Vytorin 10-20 after the Lipitor but recent studies questioned the effectiveness fo Vytorin and some concerns about connection to cancer. Doc tried to switch me back to Lipitor but my health plan no longer cover it so that is why I am on Zocor 10mg. For me statin is statin and being Asian, it builds up too quickly and doesn’t flush out like normal people. Just trying to help people understand they are not alone with the body achs and pains and give some insight in how I dealt with it.
10 Michael Edwards // Jan 30, 2010 at 12:02 am
I have been on Lipitor in increasing amounts for about 17 years. AARP United Healthcare/SecureHorizons promise that you can take Lipitor in whatever dosage your DR recommends although it is a Tier 2, which I accepted.
However, this is a deception & untrue. UnitedHealthcare refused to authorize my Doctors prescriptions of Lipitor in favor of the less effective (and less costly) Zocor. Healthcare insurance companies can say anything they want with impunity. Healthcare insurance reform must include teeth to force companies like AARP UnitedHealthcare and SecureHorizons to stop deceiving their customers.
11 joan // Jan 30, 2010 at 1:42 pm
lipitor caused me so many muscle problems my dr. took me off it and switched to zocor a lesser amt hope it works at first sign of any muscle problems i will stop it fast
12 Joe // Feb 2, 2010 at 1:48 pm
Can switch from Lipitor to Simvastatin without any problems or time to wean off of the lipitor?
13 Ron // Feb 9, 2010 at 1:48 pm
Currently taking 10 mg of Lipitor for a couple years now. My cholesterol or lipid profile is as follows:
Total cholesterol: 197
HDL cholesterol: 48
Triglycerides: 56
LDL cholesterol: 138
My doctor wants to switch me from 10 mg of Lipitor to 40 mg of Simvastatin. My question: Is 40 mg of Simvasatin four times the strength as 10 mg of Lipitor?
14 Michael Edwards // Feb 10, 2010 at 7:36 pm
I had a no fasting reading of 213 Triglycerides in Oct while on 60 mg’s Lipitor (181 total Cholesterol, 56 HDL, & 93 LDL) I can’t imagine what my Triglycerides will be on Simvastatin. Anybody know how I can get justify getting back on Lipitor? I don’t like being a lab rat for AARP’s United Healthcare.
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