An excerpt from the Johns Hopkins Medical Letter: Health After 50 Is there a "best" statin drug?
	You're on Lipitor, your cousin takes Pravachol, and a friend's doctor just started him on Zocor. Why the differences? If you're among the millions of men and women taking a statin drug to reduce cholesterol, or are a candidate for starting on one, you may wonder what factors a doctor considers when prescribing a specific statin. Is there a "best" statin? Should your personal preferences be taken into account? How statins work All statins reduce cholesterol by at least 20% through the same basic action: They inhibit a key enzyme that controls how much cholesterol is produced by the liver. The result is lower LDL (the "bad" cholesterol), higher HDL (the "good" kind), and a reduction in triglyceride levels as well. After 6 weeks in a randomized controlled trial that compared the potency of the various statins, Crestor (rosuvastatin) lowered LDL cholesterol by 46% to 55%... Lipitor (atorvastatin) by 37% to 51%... Zocor (simvastatin) by 28% to 46%... Pravachol (pravastatin) by 20% to 30%. But in addition to potency, other medical and nonmedical factors may influence statin choice. They include: 1. Cost. Statins vary widely in price from about $37 for 30 tablets of the 20 mg dose size of generic Mevacor (lovastatin) to $117 for brand-name Zocor. 2. When to take. Some are taken in the evening or at bedtime for maximum effect, while others may be taken any time and one must be taken with meals. 3. Drug interactions. Some may interact with certain drugs because they are metabolized by the same enzyme system, while others are less prone to the interaction. Safety data on Crestor are limited because the drug is so new. Health After 50 Medical Editor Simeon Margolis cautions that "although the potency of Crestor appears to be fully established, its safety is not. Unless there is an overwhelming reason to take a very new drug, the best approach is to wait for some time to pass to allow unforeseen problems, if any, to be detected." 4. Side effects. Muscle pain and weakness (myopathy) is the most common side effect for all the statins. An uncommon side effect of all statins is an increase in liver enzymes.
The Stats on Statins Drug Daily Dosage Estimated Cost* Efficacy † Drug Interactions When to Take Lipitor (Atorvastatin) 10 to 80 mg 10 mg: $63 2 May interact with certain drugs, including erythromycin, antifungals, and cyclosporine Any time Lescol (Fluvastatin) 20 to 80 mg 80 mg XL: $63 5 Drug interactions appear less likely Evening Mevacor § (Lovastatin) 20 to 80 mg 40 mg: $122 ($63 for generic) 4 Similar to atorvastatin Evening (with food) Pravachol (Pravastatin) 10 to 80 mg 40 mg: $117 4 Drug interactions appear less likely Evening Crestor (Rosuvastatin) 10 to 40 mg 10 mg: $70 1 Drug interactions appear less likely; limited long-term safety data Any time Zocor (Simvastatin) 10 to 80 mg 20 mg: $117 3 Similar to atorvastatin Evening * Estimated cost of 30 tablets or capsules for commonly used doses (Drugstore.com October 2003) † Relative overall LDL-lowering effect at starting dose, with 1 being the most potent; the magnitude of the triglyceride-lowering effect is similar. § Only statin available as a generic. For more healthy living advice for men and women over 50, subscribe today to Johns Hopkins Medical Letter: Health After 50.

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