Fermentation-derived and synthetic
The statins are divided into two groups: fermentation-derived and synthetic.
The statins include, in alphabetical order (brand names vary in different countries):
|Cerivastatin||Lipobay, Baycol. (Withdrawn from the market in August, 2001 due to risk of serious Rhabdomyolysis)||Synthetic|
|Fluvastatin||Lescol, Lescol XL||Synthetic|
|Lovastatin||Mevacor, Altocor, Altoprev||Fermentation-derived. Naturally-occurring compound. Found in oyster mushrooms and red yeast rice.|
|Mevastatin||-||Naturally-occurring compound. Found in red yeast rice.|
|Pravastatin||Pravachol, Selektine, Lipostat||Fermentation-derived|
|Simvastatin||Zocor, Lipex||Fermentation-derived. (Simvastatin is a synthetic derivate of a fermentation product)|
|Lovastatin+Niacin extended-release||Advicor||Combination therapy|
|Atorvastatin+Amlodipine Besylate||Caduet||Combination therapy - Cholesterol+Blood Pressure|
|Simvastatin+Niacin extended-release||Simcor||Combination therapy|
LDL-lowering potency varies between agents. Cerivastatin is the most potent, followed by (in order of decreasing potency), rosuvastatin, atorvastatin, simvastatin, lovastatin, pravastatin, and fluvastatin. The relative potency of pitavastatin has not yet been fully established.
Some types of statins are naturally occurring, and can be found in such foods as oyster mushrooms and red yeast rice. Randomized controlled trials found them to be effective, but the quality of the trials was low..
No large scale comparison exists that examines the relative effectiveness of the various statins against one another for preventing hard cardiovascular outcomes, such as death or myocardial infarction.
An independent analysis has been done to compare atorvastatin, pravastatin and simvastatin, based on their effectiveness against placebos. It found that, at commonly prescribed doses, there are no statistically significant differences amongst statins in reducing cardiovascular morbidity and mortality. The CURVES study, which compared the efficacy of different doses of atorvastatin, simvastatin, pravastatin, lovastatin, and fluvastatin for reducing LDL and total cholesterol in patients with hypercholesterolemia, found that atorvastatin was more effective without increasing adverse events.
Statins differ in their ability to reduce cholesterol levels. Doses should be individualized according to patient characteristics such as goal of therapy and response. After initiation and/or dose changes, lipid levels should be analyzed within 1–3 months and dosage adjusted accordingly, then every 6–12 months afterwards.
|Statin Equivalent Dosages|
|% LDL Reduction (approx.)||Atorvastatin||Fluvastatin||Lovastatin||Pravastatin||Rosuvastatin||Simvastatin|
|10-20%||--||20 mg||10 mg||10 mg||--||5 mg|
|20-30%||--||40 mg||20 mg||20 mg||--||10 mg|
|30-40%||10 mg||80 mg||40 mg||40 mg||5 mg||20 mg|
|40-45%||20 mg||--||80 mg||80 mg||5–10 mg||40 mg|
|46-50%||40 mg||--||--||--||10–20 mg||80 mg|
|50-55%||80 mg||--||--||--||20 mg||--|
|Starting dose||10–20 mg||20 mg||10–20 mg||40 mg||10 mg; 5 mg if hypothyroid, >65 yo, Asian;||20 mg|
|If higher LDL reduction goal||40 mg if >45%||40 mg if >25%||20 mg if >20%||--||20 mg if LDL >190||40 mg if >45%|
|Optimal timing||Anytime||Evening||With evening meals||Anytime||Anytime||Evening|
Statins vary in cost from $4 to $150 a month in the USA. Some are available as low as $4.00 for a month's supply through Wal-Mart pharmacies.Consumer Reports recommends generic lovastatin, pravastatin, and simvastatin as cost-efficient "Best Buy" alternatives to more expensive branded drugs, for those in whom it is suitable.
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