Statin Drugs

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):

StatinBrand nameDerivation
AtorvastatinLipitor, TorvastSynthetic
CerivastatinLipobay, Baycol. (Withdrawn from the market in August, 2001 due to risk of serious Rhabdomyolysis)Synthetic
FluvastatinLescol, Lescol XLSynthetic
LovastatinMevacor, Altocor, AltoprevFermentation-derived. Naturally-occurring compound. Found in oyster mushrooms and red yeast rice.
Mevastatin-Naturally-occurring compound. Found in red yeast rice.
PitavastatinLivalo, PitavaSynthetic
PravastatinPravachol, Selektine, LipostatFermentation-derived
RosuvastatinCrestorSynthetic
SimvastatinZocor, LipexFermentation-derived. (Simvastatin is a synthetic derivate of a fermentation product)
Simvastatin+EzetimibeVytorinCombination therapy
Lovastatin+Niacin extended-releaseAdvicorCombination therapy
Atorvastatin+Amlodipine BesylateCaduetCombination therapy - Cholesterol+Blood Pressure
Simvastatin+Niacin extended-releaseSimcorCombination 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.

Naturally-occurring statins

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..

Comparative effectiveness

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.

Statin equivalence

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.)AtorvastatinFluvastatinLovastatinPravastatinRosuvastatinSimvastatin
10-20%--20 mg10 mg10 mg--5 mg
20-30%--40 mg20 mg20 mg--10 mg
30-40%10 mg80 mg40 mg40 mg5 mg20 mg
40-45%20 mg--80 mg80 mg5–10 mg40 mg
46-50%40 mg------10–20 mg80 mg
50-55%80 mg------20 mg--
56-60%--------40 mg--
Starting dose
Starting dose10–20 mg20 mg10–20 mg40 mg10 mg; 5 mg if hypothyroid, >65 yo, Asian;20 mg
If higher LDL reduction goal40 mg if >45%40 mg if >25%20 mg if >20%--20 mg if LDL >19040 mg if >45%
Optimal timingAnytimeEveningWith evening mealsAnytimeAnytimeEvening

Cost effectiveness

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.

Further Reading


This article is licensed under the Creative Commons Attribution-ShareAlike License. It uses material from the Wikipedia article on "Statin" All material adapted used from Wikipedia is available under the terms of the Creative Commons Attribution-ShareAlike License. Wikipedia® itself is a registered trademark of the Wikimedia Foundation, Inc.

Last Updated: Feb 1, 2011

Read in | English | Español | Français | Deutsch | Português | Italiano | 日本語 | 한국어 | 简体中文 | 繁體中文 | العربية | Dansk | Nederlands | Finnish | Ελληνικά | עִבְרִית | हिन्दी | Bahasa | Norsk | Русский | Svenska | Magyar | Polski | Română | Türkçe
Comments
The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News-Medical.Net.
Post a new comment
Post
You might also like... ×
Women living with diabetes, high cholesterol less likely to reach treatment goals