Crestor, Lipitor, or Zocor – Which statin is right for you?

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A diagnosis of high cholesterol can be intimidating, but there is a lot you can do to control this condition. In addition to modifying your diet and upping your exercise, the addition of a HMG-CoA Reductase Inhibitor — a class of drugs commonly called “statins” — can safely and effectively lower your cholesterol. (HMG-CoA Reductase helps our liver produce cholesterol; when the chemical is inhibited, the amount of cholesterol is correspondingly reduced.) For people with heart disease, statins can lower the risk of a cardiac event and subsequent death. If you and your doctor have determined that you need a statin, how can you pick the right statin for your needs?

There are six statins on the market: atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin. They differ in their ability to reduce cholesterol, and they also differ in their rates of reducing heart attacks. Their costs are also quite different — and since most people take statins for a long time, the costs add up over the years. With all of these variables, choosing the right statin for you can be complex.

All statins are capable of lowering LDL (“bad”) cholesterol and triglycerides, and raising HDL (“good”) cholesterol. The statins do differ in how effectively they can do this, and it is highly dose-dependent. Says Drug Digest:

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%, simvastatin (Zocor), atorvastatin (Lipitor), or rosuvastatin (Crestor) would be needed.

Indeed, the best-known statins are Crestor, Lipitor, and Zocor (quite probably because they have the greatest effect on cholesterol levels). The latter two are also endorsed by Consumer Reports. Taking evidence for effectiveness, safety, and cost into account, the publication rated both of these statins as “Consumer Reports Best Buy Drugs.” They recommend:

• Generic simvastatin (20mg or 40 mg) — if you need 30% or greater LDL reduction and/or have heart disease or diabetes, or if you have had a heart attack or have acute coronary syndrome and your LDL level is not highly elevated.
• Atorvastatin (Lipitor) (40mg or 80mg) — if you have had a heart attack or have acute coronary syndrome and your LDL is highly elevated; use for two years and then reconfirm need or switch to generic simvastatin.

Charts on Drug Digest have some great comparisons. For instance, they show that Lipitor (10-80 mg.) can reduce total cholesterol by 25-45%, while Zocor (5-80 mg.) can reduce the same numbers by 19-36%, and Crestor (5-40 mg.) can reduce it by 33-46%. As for lowering HDL, Lipitor can offer reduction of 5-9%, Zocor lessens HDL by 8-16%, and Crestor lowers these numbers by 8-14%. As you can see, choosing the proper statin has a lot to do with which numbers (Total Cholesterol, HDL, LDL, or triglycerides) you are trying to effect.

A final consideration is that last year there was reporting on an observational study done by Pfizer that suggested that there were certain benefits to using Lipitor over Crestor. However, one must keep in mind that Pfizer conducted the study, and they are the manufacturer of Lipitor, and they are defending this drug against Merck’s Zocor product, which is now available in a generic formula. Here is the information as presented by The Wall Street Journal:

An analysis, published in the latest Clinical Therapeutics Journal, mined a large database of health-care records and found that patients taking Lipitor had a 12% lower risk of a cardiovascular event than those on simvastatin, the generic name for Zocor. The patients on Lipitor had a 15% lower risk of having a heart attack.

So-called observational studies like this one that look at data after the fact aren’t as powerful as prospective clinical trials. Jack Tu, a cardiologist who specializes in outcomes research at Canada’s Institute for Clinical Evaluative Sciences, says the latest Pfizer study didn’t take into account factors that could predispose a patient to heart problems, such as smoking and cholesterol levels. “Just on this alone, you wouldn’t recommend that everyone should switch onto Lipitor,” he says.

Still, Pfizer hopes that doctors will take notice. “We’ve done two rather large observational studies and patients have a lower risk of cardiovascular events on Lipitor [compared with] simvastatin,” says Susan Shiff, Pfizer’s team leader for cardiovascular outcomes. “Doctors need to factor this into discussions with patients.”

You should definitely discuss with your physician which statin is right for you. In general, the best plan is to take the LOWEST dose of a statin that gets you to your target level for cholesterol. Overly large doses can be harmful to your liver and to your muscles. If you experience muscle aches and pains when taking a statin, contact your doctor immediately.

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  • sal

    crestor and lipitor MAY have triggered a cardiac arrythmia in my case. Zocor has not.

  • R4ichard Tansey

    In about four year’most people notice muscle atrophy,statin’e are co-q-10 depletors and are needed,for heart function.There on t.v.now,do research.The medical feild is a business.do your own reserch,it was never chelestrol, read

  • Emmanuel

    my doctor prescribed me today 10 mg. Simvastatin and continue 4,000 mg/day OTC fish oil..is this enough for: Cholesterol (total)236, Triglycerides 279, HDL 37, VLDL 56 and LDL 143..Thanks..

  • http://aol.com Richard Tansey

    Recently ive seen two commercials pulled from T.V.for co-q-10 witch said needed if statin’s are taken.Do your own reserch.The only one you can trust is your self.When monitory gain is the motive,wake up before, I have nothing to gain,so why lie,what dose celestriol catch on to,common sence is your best defence

  • Jim69

    9 months ago I switched from Lipitor 40mg to Simvastatin 80 mg. I now have a lot of muscil sorness I never had in the past. In July this year I tore my Bicepts and Rotator in my right arm with a weight that was much lower then I had used in the past. Could the cahnge in medicine be the cause of the damagge. I am still not back to work and probably won’t go until Jan 2012.

  • Jeanette Lyles

    I have aways heard that stopping suddenly taking statins is not good. Why is this never mentioned anymore?

  • Javier L.

    I recently switch from Simvastatin to Crestor, and now I’m having some ED problems. Has anyone had this problem with this pill? I mean, the erection is good but it won’t last that long like it used to. Should I blame Crestor for it?

  • wintermyst

    costco in canada 10mg crestor brand name.. 30 tabs 48.44 Check at Sams or Costco, you do not need a card for prescriptions.

  • David Farrell

    Several years ago my Dr. put me on Lipitor.I developed a sever lower back pain that made it very dificult getting into my car.My wife by chance mentioned to her girlfriend about my pain. She asked if I was on Lipitor. She suggested it may be the problem.I stopped taken Lipitor on my own and after a week my pain was gone.Told my Dr. and he put me on Crestor.Have not had a problem since.That was several years ago.

  • Khalid Farooq

    I was taking 10 mg Lipitor for about 5 years. Now my doctor has switched me to 10 mg Crestor. With both medicine, my lipid profile is almost good and same. I am only worried about the new research indicating that using statin rapidly increasing chances of getting diabetes.
    Any comments /suggestions

  • Retiredroxy

    @Robin N.

  • Fullcanadian

    @Michael Edwards It’s so sad that u r in the U.S.A here in Canada if u can’t pay for it the Doctor well give it to u for free and there many places in Canada where u don’t have to pay for any meds at all for the rest of your life and you can have a good job and you still don’t have to pay for your meds.

  • RichardTansey

    SINCE WE AGREE THERE ALL STATIN’S,THE QUESTION SHOULD BE IS IT A GUN, A KNIFE ,OR HANGING BEST WAY TO DIE .IN THE END THE RESULT IS ALL THE SAME.THEY ARE ALL CO-Q-10 DEPLETORS,AND YOU ALL KNOW WHAT THAT DOSE

  • Linda01247

    I also was on Simvastatin before Lipitor went generic.  I had so much muscle pain I could barely play golf.  My liver functions were way up.  He just changed me to generic Lipitor in March.  My muscle pain is gone or just about gone.  I feel so much better.  Also, my liver functions are now back to normal.

  • memo s

    martha in walmart and walgreens they have a little machine that has a rubber inside where you can put the pill in between the 2 peices of rubber. You shut the machine after you lodge the pill inside, and it splits it perfectly in 2 with a very sharp razor blade on the top side of the machine. Its called a pill cutter machine. It works so well for me. I split my simvastatin till it gets to 5mg

  • EYEM

    bad move dude. Simvastattib 80 mg is now being considered to be withdrawn because of the side effects. You should have switched to rosuvastatin.

  • EYEM

    You are correct, lipid profile may be just be the same, but with rosuvastatin, what you do not know is that atherosclerosis is being reversed. So it means that you will be having lower risk of having a CHD event.

  • Nurse

    You do not want to reduce HDL but raise it as it is the healthy cholesterol. Check the information you are providing as you are falsely telling people statins lower HDL instead of increasing it.

  • rpflemo

    my sister in law is on Crestor for some months, she has developed a skin condition all over arms, and body, not on face.  Very dry, itchy, looks like old crocodile skin, 5 months wait to see specialist, what did you do. Robyn

  • time1865

    I have been taking Astrazeneca and Simvasatin for 5 years since I had 2 stints put in for partial blockages. I was 55 at the time. At the moment I have horrible leg muscle and tendon pain along with 50% of the other “possible” side effects “rarely” seen. I can barely walk, have no memory and the list goes on and on. None of these problems I had before talking these drugs.

  • bAnn805

    This article talks about lowering HDL. I believe they mean to say LDL. HDL is the “good” cholesterol where a higher number is better. A mistake like this in an article providing medical information is unacceptable.

  • Arif Daleel

    I was on Lipitor for one year and I felt general weakness and sometimes sight problems, doctor changed medications to Crestor since nine months. Now i have experience pain in legs and difficult to walk properly. I stopped medication since one week but going on diets with much lower or nil fatty products. Not I feel active with normal life. I know that I need medication but on the very minimum dose as precaution.

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