Medications: Statins (HMG-CoA reductase inhibitors)
About 9 percent of the cholesterol-lowering drugs taken by Americans are statins. The drugs in this class are associated with few side effects and are the most effective drugs for lowering total and LDL cholesterol levels and for reducing the risk of heart attack. Statins also help lower the risk of stroke and, in people with coronary heart disease, the need for bypass surgery and angioplasty.
The statins include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), and rosuvastatin (Crestor). Lovastatin, the only statin available as a generic, is also available in combination with extended-release niacin and is sold under the brand name Advicor. In addition, the FDA recently approved a pill called Caduet, which combines atorvastatin and the blood pressure-lowering drug amlodipine, for the treatment of elevated cholesterol levels in people who also have hypertension. And more recently the FDA approved Vytorin, a pill containing both simvastatin and the cholesterol absorption inhibitor ezetimibe.
Statins produce about a 25 percent to 55 percent reduction in levels of LDL cholesterol, a 5percent to 15 percent increase in HDL cholesterol levels, and a 10 percent to 25 percent reduction in triglyceride levels. The relative efficacy of the statins for lowering LDL cholesterol and triglyceride levels is as follows: rosuvastatin has the most potent effect, followed by atorvastatin, simvastatin, pravastatin, lovastatin, and fluvastatin. The ability to lower LDL cholesterol levels is usually the most important factor to consider when choosing a statin, but other considerations include a patient's level of coronary heart disease risk, differences in side effects, drug interactions, cost, results of clinical trials, and the time of day a dose should be taken.
Side effects are uncommon, occurring in only 1 percent to 2 percent of people. For more on side effects, see Lipid-Lowering Drugs (PDF).
