Which drugs are the statin drugs?
There are currently 5 statins on the market:
- atorvastatin (Lipitor)
- fluvastatin (Lescol)
- lovastatin (Mevacor)
- pravastatin (Pravachol)
- simvastatin (Zocor)
A sixth statin, cerivastatin (Baycol) was removed from the market during the summer of 2001 because of potentially serious side effects. (Click here for a review of why Baycol was removed from the market, and what that means for other statins.)
How do statins work?
Statins reduce the liver's production of cholesterol, and increase the ability of the liver to remove LDL cholesterol ("bad" cholesterol) from the blood. They significantly reduce the level of LDL cholesterol in the blood. They also have a moderate ability to reduce triglyceridelevels, and increase levels of HDL cholesterol("good" cholesterol.)
Which patients benefit from statins? # 1 - people with a high risk of developing cardiac disease
Patients with elevated LDL cholesterol or elevated total cholesterol, especially if they have other risk factors for cardiac disease, often benefit from the use of statins. Two large randomized trials have shown that patients with elevated cholesterol levels experienced a significant decrease in the risk of heart attacks and death when treated with statins. Click here for a brief review of risk assessment.
Which patients benefit from statins? # 2 - people who already have coronary artery disease
Three large studies have now shown that, in patients who have already had heart attacks, the use of statins reduced the risk of developing a second heart attack by over 30%, and the risk of death by over 40%. Most survivors of heart attacks should be treated with statins.
Which patients benefit from statins? # 3 - other people who may benefit
Preliminary studies suggest that statins may help prevent the onset of Alzheimer's Disease. Clinical trials are now underway to study this possible benefit. Similarly, other preliminary studies suggest that statins may reduce the risk of stroke, and may help prevent osteoporosis. Statins are not yet approved for these indications, however.
Which statin is "best?"
In general, statins have been thought of as a class of drugs - that is, for years there seemed to be relatively little to distinguish between them. However, as more powerful statins have been developed, there are now certain distinguishing features. For the most part, doctors decide which statin to use based on three factors: effectiveness in reducing cholesterol, effectiveness in clinical trials, and cost.
To a large extent, however, statins can be used interchangeably.
Distinguishing features among statins
- While all statins significantly reduce cholesterol, atorvastatin and simvastatin seem to reduce cholesterol levels to a greater extent.
- Evidence of effectiveness in clinical trials is particularly strong for lovastatin, pravastatin, and simvastatin.
- While the cost of statins varies wildly, in general fluvastatin is the cheapest, and atorvastatin and simvastatin are the most expensive.
- Simvastatin appears to increase HDL cholesterol to a greater extent than other statins.
- Simvatatin was used in the Heart Protection Study- a study showing for the first time that statins significantly reduce heart attack and stroke in high risk patients regardless of cholesterol levels.
- Lovastatin will become a generic drug in 2002, and the price will drop significantly.
Click here for more information on the differences among the various statin drugs.
