Statins are medicines that can lower cholesterol. They work either by blocking a substance the body needs to make cholesterol, or by helping the body reabsorb cholesterol that is built up. Statins include several drugs that differ in several ways, such as how they work, properties, drug-food interactions and cost.
Efficacy
Examples of statin drugs include atorvastatin, or Lipitor; simvastatin, or Zocor; pravastatin, or Pravachol; rosuvastatin, or Crestor; lovastatin, or Mevacor; and fluvastatin, or Lescol. The "American Journal of Medicine" stated in 2001 that atorvastatin and simvastatin are the two statins that produce the greatest percentage change in LDL cholesterol. A study published in the "Annals of Pharmacotherapy" in 1995 determined that on a milligram-to-milligram basis, simvastatin is twice as potent as lovastatin and pravastatin.
Properites
The pharmacokinetic properties of the statin drugs describe how the drugs work in the body. All statins inhibit an enzyme that decreases the production of cholesterol; fluvastatin, simvastatin, lovastatin and pravastatin all have similar properties that reduce LDL cholesterol by 20 to 35 percent. However, according to the journal "Clinical Pharmacokinetics" in 1997, simvastatin has this effect at lower doses than the other three drugs. Also, different degrees of liver involvement occur with each statin; the least liver damage occurs with fluvastatin or pravastatin.
Drug Metabolism and Interactions
Most of the statins are metabolized, or broken down, in the liver. Rosuvastatin is mainly excreted in the bile in its unchanged form. The elimination half-lives of the statins differ; lovastatin and simvastatin display half-lives of one to three hours, while rosuvastatin can take 19 hours to clear. The "Netherlands Heart Journal" in 2006 stated that drug interactions between statins and other prescription medications are determined by how the statin is metabolized. Atorvastatin and simvastatin can accumulate in the body due to intake of some drugs, and with grapefruit juice. Pravastatin and rosuvastatin are much less susceptible to such interactions.
Cost
The "American Journal of Medicine" states that the most cost-effective statins, based on cost per percentage change in LDL cholesterol levels, are atorvastatin and fluvastatin. A study published in 2006 by the "American Journal of Cardiovascular Drugs" found that 10 mg per day of atorvastatin was the most cost-effective treatment, followed by 10 mg per day of simvastatin, 20 mg per day of lovastatin and 20 mg per day of fluvastatin. Lower-cost generic versions of many statin medications are available.
References
- "American Journal of Medicine"; Clinically Relevant Differences Between the Statins, P.H. Chongm et al.; October 2001
- "Netherlands Heart Journal"; The Statins: Similarities and Differences; P.A. van Zwieten; March 2006
- "Clinical Pharmokinetics"; Pharmacodynamics and Pharmacokinetics of the HMG-CoA Reductase Inhibitors. Similarities and Differences; H. Lennerhas, et al.; May 1997
- "American Journal of Cardiovascular Drugs"; Cost-Effectiveness Analysis of Cholesterol-Lowering Therapies in Spain; P. Plans-Rubio, et al.; 2006
- "The Annals of Pharmacotherapy"; Comparative Evaluation of the Safety and Efficacy of HMG-CoA Reductase Inhibitor Monotherapy in the Treatment of Primary Hypercholesterolemia; I. Hsu, et al.; July-August 1995
- MayoClinic.com: Statins
