Statins, also known as HMG-CoA reductase inhibitors, can effectively reduce the levels of circulating LDL, or "bad," cholesterol. In patients at risk for heart disease, statins aid in lowering the chance of harmful cardiovascular events, such as a heart attack or stroke. Currently, the U.S. Food and Drug Administration (FDA) has approved six types of statins.
Fluvastatin
Fluvastatin is a good starting drug for a patient with mildly increased LDL level that is uncontrolled by diet and exercise. In the January 2001 issue of "American Family Physician," Dr. Michael Crouch reported that at the recommended starting dose of 20 mg, fluvastatin resulted in a 17 percent decrease in LDL level. At the maximum dose of 80 mg, it achieved a 33 percent reduction in LDL.
Fluvastatin, like all statins, should be avoided in patients who are pregnant, those with active liver disease and those with known allergy to statins. It shares the side effects common to all statins, which include mild constipation, abdominal pain and cramping. These effects usually subside as therapy continues. Myopathy, described as pain and tenderness of muscles, can also occur.
Pravastatin
FPnotebook.com reports that pravastatin can reduce the LDL level anywhere from 19 to 40 percent, depending on the dose. Compared with the other statins, it is safer to use in combination with other drugs, but should not be given to patients with kidney problems.
Lovastatin
Approved by the FDA in 1987, lovastatin has the distinction of being the first commercially-available statin. It can lower the LDL level by 29 to 48 percent, as stated in FPnotebook.com. The FDA reports that lovastatin has more adverse drug interactions than other statins. People on multiple medications, especially the elderly, should use it with caution.
Simvastatin
According to the article by Dr. Crouch, simvastatin can decrease the LDL level by 35 to 48 percent. In addition, it can result in greater increases in the level of HDL or "good" cholesterol as compared with other statins. Patients should use it at the lowest effective dose to limit the occurrence of adverse reactions.
Atorvastatin
Atorvastatin can lower the LDL levels by 38 to 54 percent, according to FPnotebook.com. It also effectively reduces triglyceride levels by as much as 40 percent.
Rosuvastatin
Rosuvastatin, the newest statin on the market, has the highest efficacy of all statins. FPnotebook.com reports that it can result in a 45 to 63 percent decrease in LDL level. The FDA recently approved rosuvastatin as the first ever statin for use in the primary prevention of heart disease, even in those patients with normal LDL levels but known to have other risk factors.
References
- "American Family Physician" Effective Use of Statins to Prevent Coronary Heart Disease; Michael A. Crouch, MD, MSPH; January 2001
- "Nature Medicine" A gift from nature: the birth of the statins; Akira Endo; October 2008
- FamilyPracticeNotebook.com; HMG-CoA Reductase Inhibitors
- FDA: Questions and Answers for Healthcare Professionals-CRESTOR and the JUPITER Trial
