Drug Comparisons

The HMG-CoA Reductase Inhibitors, commonly referred to as "statins," are considered a first-line therapy for the treatment of high cholesterol. HMG-CoA Reductase is a chemical made in our bodies that helps the liver produce cholesterol. Statins get in the way of that process, thus reducing the amount and frequency of cholesterol being produced.

Drugs in this Class
Atorvastatin (Lipitor)
Lovastatin (Mevacor)
Fluvastatin Extended-Release (Lescol XL)
Fluvastatin (Lescol)
Rosuvastatin (Crestor)
Simvastatin (Zocor)
Lovastatin Extended Release (Altocor, Altoprev)
Cerivastatin - Withdrawn From The Market (Baycol - Withdrawn From The Market)
Pravastatin (Pravachol)

Summarizing the Evidence

Many studies have been performed to compare the drugs in this class to each other. All statins can effectively lower LDL cholesterol (LDL-C or "bad cholesterol"), total cholesterol, and triglycerides. Each drug in this class can also raise HDL cholesterol (HDL-C or "good cholesterol"), which is desirable.

While each drug in this class can lower cholesterol levels, they differ by how greatly they can reduce cholesterol levels. All of the statins lower cholesterol (and raise HDL-C) in a dose-dependent manner (meaning-- the higher the statin dose, the greater the cholesterol reduction). Rosuvastatin 40mg daily has been shown in clinical trials to provide the greatest LDL-C reduction (up to 63%) compared to other statins. However, most patients do not need that great of a reduction and can be effectively treated with other statins.

If the needed LDL-C reduction is up to 35-36%, any of the statins should be acceptable choices for therapy. For a desired reduction of LDL-C greater than 42%, Zocor, Lipitor, or Crestor would be needed. The choice of which statin to use will most usually depend on how much cholesterol reduction you need plus your doctor's preference, and/or your prescription benefits formulary.

To compare the cholesterol lowering effects of the statin drugs, please refer to the tables directly below.

Comparison of Effects on Cholesterol Levels

Table Key:
TC = Total Cholesterol
LDL = Low Density Lipoprotein (or "bad cholesterol")
HDL = High Density Lipoprotein (or "good cholesterol")
TG = Triglycerides

D = Decrease
I = Increase

Comparison of Dose Effects on LDL Cholesterol (LDL-C)

Dosing and Administration

• All statins are dosed once daily.

Generic Availability

• Lovastatin (brand name: Mevacor) was the first statin approved by the FDA in August of 1987, and is now available generically. Simvastatin (brand name: Zocor) and pravastatin (brand name: Pravachol) recently became available generically in 2006. Currently lovastatin, pravastatin and simvastatin are the only statins available in the generic form.

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

References

1. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001; 285:2486-2497.
2. Mevacor [package insert]. West Point, PA: Merck & Co.; June 2002.
3. Pravachol [package insert]. Princeton, NJ: Bristol-Myers Squibb; December 2001.
4. Zocor [package insert]. West Point, PA: Merck & Co.; May 2002.
5. Lescol, Lescol XL [package insert]. East Hanover, NJ: Novartis Pharmaceuticals; October 2001.
6. Lipitor [package insert]. Morris Plains, NJ: Parke-Davis; April 2002.
7. Altocor [package insert]. Weston, FL: Andrx Laboratories, Inc.; July 2002.
8. Hsu I, Spinler S, Johnson N. Comparative evaluation of the safety and efficacy of HMG-CoA reductase inhibitor monotherapy in the treatment of primary hypercholesterolemia. Ann Pharmacother. 1995;29:743-759.
9. Levy R, Troendle A, Fattu J. A quarter century of drug treatment of dyslipoproteinemia. Circulation. 1993;87(Suppl 3):45-53.
10. Glaser M. Annual Rx Survey. Drug Topics. 1996; 140(7):97-98,100,102,104.
11. Hilleman DE, Phillips JO, Mohiuddin SM, Ryschon KL, Pedersen CA. A population-based treat to target pharmacoeconomic analysis of HMG-CoA reductase inhibitors in hypercholesterolemia. Clin Ther. 1999;21(3):536-562.
12. Yoshino G, Kazumi T, Matsushita M, et al. Comparison of the effects of pravastatin and simvastatin in hypercholesterolemic subjects. Curr Ther Res. 1990;48:259-267.
13. Malini P, Ambrosioni E, de Divitiis O, de Somma S, Rosiello G, Trimarco B. Simvastatin versus pravastatin: efficacy and tolerability in patients with primary hypercholesterolemia. Clin Ther. 1991;13:500-510.
14. Farmer J, Washington L, Jones P, et al. Comparative effects of simvastatin and lovastatin in patients with hypercholesterolemia. Clin Ther. 1992;14:708-717.
15. McPherson R. Comparison of the short-term efficacy and tolerability of lovastatin and pravastatin in the management of primary hypercholesterolemia. Clin Ther. 1992;14:276-291.
16. The European Study Group. Efficacy and tolerability of simvastatin and pravastatin in patients with primary hypercholesterolemia (multicountry comparative study). Am J Cardiol. 1992;70:1281-1286.
17. Lintott C, Scott R, Sutherland W, Bremer J. Treating hypercholesterolaemia with HMG CoA reductase inhibitors: a direct comparison of simvastatin and pravastatin. Aust N Z J Med. 1993;23:381-386.
18. Stalenhoef A, Lansberg P, Kroon A, et al. Treatment of primary hypercholesterolaemia. Short-term efficacy and safety of increasing doses of simvastatin and pravastatin: a double-blind comparative study. J Intern Med. 1993; 234:77-82.
19. The Lovastatin Pravastatin Study Group. A multicenter comparative trial of lovastatin and pravastatin in the treatment of hypercholesterolemia Am J Cardiol. 1993; 71:810-815.
20. The Simvastatin Pravastatin Study Group. Comparison of the efficacy, safety and tolerability of simvastatin and pravastatin for hypercholesterolemia. Am J Cardiol. 1993;71:1408-1414.
21. Simvastatin Pravastatin European Study Group. Comparative efficacy and tolerability of 5 and 10 mg simvastatin and 10 mg pravastatin in moderate primary hypercholesterolemia. Cardiology. 1994;85:244-254.
22. Jacotot B, Benghozi R, Pfister P, Holmes D. Comparison of fluvastatin versus pravastatin treatment of primary hypercholesterolemia (the French Fluvastatin Study Group). Am J Cardiol. 1995;76(Suppl A):54A-56A.
23. Lambrecht L, Malini P. The European Study Group. Efficacy and tolerability of simvastatin 20 mg vs. pravastatin 20 mg in patients with primary hypercholesterolemia. Acta Cardiologica. 1993;XLVIX:541-554.
24. Douste-Blazy P, Ribeiro VG, Seed M. The European Study Group. Comparative study of the efficacy and tolerability of simvastatin and pravastatin in patients with primary hypercholesterolaemia. Drug Invest. 1993;6(6):353-361.
25. Best J, Nicholson G, O'Neal D, et al. Atorvastatin and simvastatin reduce elevated cholesterol in noninsulin dependent diabetes. Diab Nutr Metab. 1996;9:74-80.
26. Illingworth DR, Bacon S, Pappu AS, Sexton GJ. Comparative hypolipidemic effects of lovastatin and simvastatin in patients with heterozygous familial hypercholesterolemia. Atherosclerosis. 1992;96:53-64.
27. Wolffenbuttel BH, Mahla G, Muller D, Pentrup A, Black DM. Efficacy and safety of a new cholesterol synthesis inhibitor, atorvastatin, in comparison with simvastatin and pravastatin, in subjects with hypercholesterolemia. Neth J Med. 1998;52:131-137.
28. Jones P, Kafonek S, Laurora I, Hunninghake D. Comparative dose efficacy study of atorvastatin versus simvastatin, pravastatin, lovastatin, and fluvastatin in patients with hypercholesterolemia (the CURVES study). Am J Cardiol. 1998;81:582-587.
29. Dart A, Jerums G, Nicholson G, et al. A multicenter, double-blind, one-year study comparing safety and efficacy of atorvastatin versus simvastatin in patients with hypercholesterolemia. Am J Cardiol. 1997;80:39-44.
30. Davidson M, McKenney J, Stein E, et al. Comparison of one-year efficacy and safety of atorvastatin versus lovastatin in primary hypercholesterolemia. Atorvastatin Study Group I. Am J Cardiol. 1997;79:1475-1481.
31. Bertolini S, Bon GB, Campbell LM, et al. Efficacy and safety of atorvastatin compared to pravastatin in patients with hypercholesterolemia. Atherosclerosis 1997;130:191-197.
32. Stein EA, Lane M, Laskarzewski P. Comparison of statins in hypertriglyceridemia. Am J Cardiol. 1998;81(4A):66B-69B.
33. Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med. 1995;333:1301-1307.
34. Furberg CD, Adams HP, Applegate WB, et al. Effect of lovastatin on early carotid atherosclerosis and cardiovascular events. Circulation. 1994;90(4):1679-1687.
35. Downs JR, Clearfield M, Weis S, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels; results of AFCAPS/TexCAPS. JAMA. 1998;279:1615-1622.
36. Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383-1389.
37. Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med. 1996;335(14):1001-1009.
38. Schwartz GG, Olsson AG, Ezekowitz MD, et al., for the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering Study Investigators. Effects of atorvastatin on early recurrent ischemia events in acute coronary syndromes. The MIRACL Study: a randomized controlled trial. JAMA. 2001;285:1711-1718.
39. Pitt B, Mancini J, Ellis SG, Rosman HS, Park J-S, McGovern ME. Pravastatin limitation of atherosclerosis in the coronary arteries (PLAC I): reduction in atherosclerosis progression and clinical events. J Am Coll Cardiol. 1995;26:1133-1139.
40. Crouse J, Byington R, Bond M, et al. Pravastatin, Lipids, and Atherosclerosis in the Carotid Arteries (PLAC-II): a clinical trial with atherosclerosis outcome. Am J Cardiol. 1995;75:455-459.
41. Jukema J, Bruschke A, van Boven A, et al. Effects of lipid lowering by pravastatin on progression and regression of coronary artery disease in symptomatic men with normal to moderately elevated cholesterol levels: the Regression Growth Evaluation Statin Study (REGRESS). Circulation. 1995;91:2528-2540.
42. Byington R, Jukema J, Salonen J, et al. Reduction in cardiovascular events during pravastatin therapy. Pooled analysis of clinical events of the Pravastatin Atherosclerosis Intervention Program. Circulation. 1995;92:2419-2425.
43. Blankenhorn D, Azen S, Kramsch D, et al. Coronary angiographic changes with lovastatin therapy: the Monitored Atherosclerosis Regression Study (MARS). Ann Intern Med. 1993;119:969-976.
44. Brown G, Albers JJ, Fisher LD, et al. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med. 1990;323(19):1289-1298.
45. Plehn JR, Davis BR, Sacks FM, et al. Reduction of stroke incidence after myocardial infarction with pravastatin: The cholesterol and recurrent events (CARE) study. Circulation. 1999;(2):216-223.
46. The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339(19):1349-1357.
47. Bestehorn HP, Rensing UF, Roskamm H, et al. The effect of simvastatin on progression of coronary artery disease. The Multicenter Coronary Intervention Study (CIS). Eur Heart. 1997;18(2):226-234.
48. Herd JA, Ballantyne CM, Farmer JA, et al. Effects of fluvastatin on coronary atherosclerosis in patients with mild to moderate cholesterol elevations (Lipoprotein and Coronary Atherosclerosis Study [LCAS]). Am J Cardiol. 1997;80(3):278-286.
49. Egashira K, Hirooka Y, Kai H. Reduction in serum cholesterol with pravastatin improves endothelium-dependent coronary vasomotion in patients with hypercholesterolemia. Circulation. 1994;89:2519-2524.
50. Torri A, Sommariva D, Maraffi F, et al. Long term effects of low dose simvastatin in hypercholesterolemic Type 2 diabetic patients. Curr Ther Res Clin. 1992;51:28-36.
51. McDowell IFW, Smye M, Trinick T, et al. Simvastatin in severe hypercholesterolaemia: a placebo controlled trial. Br J Clin Pharmacol. 1991;31:340-343.
52. Bergstrom JD, Bostedor RG, Rew DJ, Geissler WM, Wright SD, Chao YS. Hepatic responses to inhibition of 3-hydroxy-3-methylglutaryl-CoA reductase: a comparison of atorvastatin and simvastatin. Biochem Biophys Acta. 1998;1389:213-221.
53. Gotto AM. Lipid lowering, regression, and coronary events. A review of the interdisciplinary council on lipids and cardiovascular risk intervention, seventh council meeting. Circulation. 1995;92:646-656.
54. Bradford R, Shear C, Chremos A, et al. Expanded clinical evaluation of lovastatin (EXCEL) study results: efficacy in modifying plasma lipoproteins and adverse event profile in 8245 patients with moderate hypercholesterolemia. Arch Intern Med. 1991;151:43-49.
55. Vega G, Grundy S. Management of primary mixed hyperlipidemia with lovastatin. Arch Intern Med. 1990;150:1313-1319.
56. Clinical Pharmacology Online; [modified 2006; cited 2007 19 Jan].Available from: http://cpip.gsm.com.stlcopisa.stlcop.edu/
57. Scriptcare. Generic Drug News; c2006 [cited 2007 Jan 19]. Available from www.scriptcare.com/scInfoNewsStory.asp?id=89

Last Updated: December 2007
This content was created by members of the DrugDigest team of experts and is solely under DrugDigest's editorial control.

Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It should not be construed to indicate that the use of the product is safe, appropriate, or effective for you. Consult your healthcare professional before taking any medication.