What are the statin drugs?
The statins are the most widely used, and also the most powerful medications for lowering LDL cholesterol. Numerous large, randomized, double-blind, placebocontrolled, , clinical trials controlled trials) have shown that statins reduce heart attacks (and strokes) and improve survival. Statins are well tolerated with low side effect rates when used long term. Statins not only lower blood LDL cholesterol levels, they also modestly increase HDL cholesterol levels andmodestly decrease triglyceride levels. The statins that are now on pharmacy shelves in the U.S. (putting the generic name first followed by the brand name in
parentheses) are:
- rosuvastatin ( Crestor)
- fluvastatin sodium (Lescol) made by Novartis
- atorvastatin calcium (Lipitor) made by Parke-Davis and Pfizer
- lovastatin (Mevacor) made by Merck
- pravastatin sodium (Pravachol) made by Bristol-Myers Squibb
- simvastatin (Zocor) made by Merck
Studies have consistently shown that lowering LDL cholesterol with diet and statins reduces the risk of a second heart attack. The prevention of recurrent heart attacks in patients who have already suffered a heart attack is called secondary prevention.
Studies have also demonstrated that reducing LDL cholesterol with lifestyle changes and statins reduces the risk of having the first heart attack. Prevention of heart attacks in those who have never had a heart attack is called primary prevention.
Studies have also confirmed that reducing LDL cholesterol benefits both men and women, and the elderly. For more, please read our article on Statins.
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How do doctors select statin drugs?
Which statin to use is an individualized decision. There are several considerations in choosing a statin:
? In patients who need intense LDL cholesterol-lowering, it is more appropriate to use one of the more potent statins, such as atorvastatin (Lipitor) or rosuvastatin (Crestor). Sometimes a statin may need to be combined with another medication such as cholestyramine (Questran), ezetimibe (Zetia) or nicotinic acid, in order to achieve the LDL cholesterol goals.
? In patients with chronic liver disease who need statin treatment, it is important to completely abstain from alcohol and use either pravastatin (Pravachol) or rosuvastatin (Crestor) in low doses. (Pravastatin and rosuvastatin are safer to use in patients with liver disease.) If LDL cholesterol goals cannot be attained with low doses of either of these two statins, cholestyramine Questran) or ezetimibe (Zetia) can be added.
? In patients who develop muscle aches or muscle damage with a statin, it may be appropriate to try another statin, such as pravastatin (Pravachol), that probably has less of a muscle toxic effect than the other statins. In patients who are at risk of developing muscle injury (for example a patient who is already taking gemfibrozil), pravastatin (Pravachol) would also be a suitable statin to use.
? Atorvastatin (Lipitor) and fluvastatin (Lescol) do not require dose adjustments in patients with kidney diseases.
Studies have also demonstrated that reducing LDL cholesterol with lifestyle changes and statins reduces the risk of having the first heart attack. Prevention of heart attacks in those who have never had a heart attack is called primary prevention.
Studies have also confirmed that reducing LDL cholesterol benefits both men and women, and the elderly. For more, please read our article on Statins.
------
How do doctors select statin drugs?
Which statin to use is an individualized decision. There are several considerations in choosing a statin:
? In patients who need intense LDL cholesterol-lowering, it is more appropriate to use one of the more potent statins, such as atorvastatin (Lipitor) or rosuvastatin (Crestor). Sometimes a statin may need to be combined with another medication such as cholestyramine (Questran), ezetimibe (Zetia) or nicotinic acid, in order to achieve the LDL cholesterol goals.
? In patients with chronic liver disease who need statin treatment, it is important to completely abstain from alcohol and use either pravastatin (Pravachol) or rosuvastatin (Crestor) in low doses. (Pravastatin and rosuvastatin are safer to use in patients with liver disease.) If LDL cholesterol goals cannot be attained with low doses of either of these two statins, cholestyramine Questran) or ezetimibe (Zetia) can be added.
? In patients who develop muscle aches or muscle damage with a statin, it may be appropriate to try another statin, such as pravastatin (Pravachol), that probably has less of a muscle toxic effect than the other statins. In patients who are at risk of developing muscle injury (for example a patient who is already taking gemfibrozil), pravastatin (Pravachol) would also be a suitable statin to use.
? Atorvastatin (Lipitor) and fluvastatin (Lescol) do not require dose adjustments in patients with kidney diseases.
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