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):

Statin	Brand name	Derivation
Atorvastatin	Lipitor, Torvast	Synthetic
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 (Withdrawn from the market in August, 2001 due to risk of serious Rhabdomyolysis)	Synthetic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.
Pitavastatin	Livalo, Pitava	Synthetic
Pravastatin	Pravachol, Selektine, Lipostat	Fermentation-derived
Rosuvastatin	Crestor	Synthetic
Simvastatin	Zocor, Lipex	Fermentation-derived. (Simvastatin is a synthetic derivate of a fermentation product)
Simvastatin+Ezetimibe	Vytorin	Combination therapy
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.

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.)	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	--
56-60%	--	--	--	--	40 mg	--
Starting dose
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

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.