Statins

[louis]

Good morning and thanks for your time. Is one statin superior to another? For example Mevacor at one point was touted as possibly preventing heart attacks, whereas Lipitor is supposed to be stronger than Mevacor. What criteria do you use to determine which one to prescribe. Are statin side effects the same across the board, regardless of which one you use?
Thanks

[Cleveland Clinic]

inky,

Its a difficult question. Up until the last year a lot of physicians thought all statins were created equal. However several trials in that time period showed that there was most likely a difference in the way these drugs work, despite having a similar mechanism of action in the body.  

The problem with extrapolating these trials is that they only looked at 2 specific statin medications when there are several out there.  

Mevacor is right stating it has been shown that it prevents heart attacks as it was shown to prevent heart attacks in a well designed prospective large trial.  Some of the other statin medications can not make the same claims as they have only been tested in safety or soft endpoint trials designed to market the medication.  These types of trials show that the medication lowers lipids or other markers, but are not powered to show the primary mortality endpoints.  You might have noticed on some of the comercials for statin medications there is a disclaimer statement saying 'this medication has not been shown to prevent heart attacks'

The bottom line from the more recent trials show that we have probably been too lax in treating cholesterol and that out targets for LDL cholesterol in the past have been too high.  Further, it is becoming clear that other markers such as CRP are becoming important to follow and guide therapy.  Current guidelines are evolving to reflect these changes.

I usually will not change a statin if a patient has very well controlled LDL and CRP levels.  If not, I generally will consider switching to a higher dose of atorvastin based on the results of the recent trials using this medication.  The whole process is quite confusing, and the information I have given you doesnt even reflect the growing recognition of the importance in HDL and other markers in the whole process. Over the next few years therapies that modify HDL will be available in addition to other potent markers of arterial inflammation such as MPO.

I think if you are having problems with side effects from your medication, or problems with poor efficacy of your current regimen it could potentially help to see a preventive cardiologist or lipid specialist.

good luck

[Barbarella]

Six months ago I was suppose to take statins because of very high Cholesterol.  My doctor said that Zocor was an excellent statin drug and 80% of his patients have no side effects.  However, I was scared to death of statins and my doctor prescribed a "none statin" which only lowered my Cholesterol 20 points and he was not very happy about that.  All of a sudden in his opinion Lipitor was "the drug" of all statin drugs and he wanted to put me on Lipitor.  I asked to be put on Zocor (as he wanted to put me on six months ago in the first place) because a friend of mine almost died of serious side effects caused by Lipitor and I was scared.  I practically had to beg him to put me on Zocor instead of Lipitor.  The point I'm making is six months ago Zocor was "the statin drug", now six months later all of a sudden Lipitor is "it".

I've been taking Zocor for two weeks now and so far no side effects whatsoever, but I take it every other day am scared to take it every day.

[Erik36]

I have been taking Zocor for three years now. I take it every day. It is very well tolerated. I have not had any side effects. It is very rare for life threatening things to happen from taking it. The benefits far outweigh the risks. Good luck!

[Barbarella]

Thanks Erik, I was thinking about starting to take it every day pretty soon, but will start tonight.

[Healthyself2]

I would say as far as effectiveness they might be ranked like this:

1. Crestor
2. Lipitor
3. Zocor
4. Pravachol
5. Others

Crestor may be pulled from the market because of a very small percentage of patients with life threatening side effects on high dosages.

I have taken 20 mg Lipitor for 4 years without noticing any side effects and have no liver problems.  Instead of taking a high dose, I take 2 other drugs in combination and have maintained an excellent lipid profile over the last years.

Zocor is probably as good, but not quite as effective as Lipitor.  HMOs prescribe it a lot because it's cheaper to them.

In my experience, Pravachol is about half as effective as Lipitor.

I think that the statins effectiveness are pretty well maxed out with Lipitor and Crestor.  We won't see another new drug in that class.  

The next drugs out will be CETP inhibitors to increase HDL which is really the problem with most CAD patients.  They will save a lot of lives and, with daily exercise, will highly reduce the need for stenting and bypass surgery.  Of course the medical profession will still overpractice these procedures because of the high revenues that they generate and their culture of denial about that situation.

Most people can avoid stenting or bypass surgery today and arrest their disease with agressive lipid therapy with multiple drugs available today and daily exercise.

[Barbarella]

You can rank the statins all you want to they are all in the same family just different names.  And a certain brand is prescribed who at that time gives the biggest kick backs or who people have invested their stocks in.  Just like VIOXX and Celebrex are in the same family.  VIOXX was pulled off the market first because a certain amount of people died from it first.  Now they are thinking strongly to pull off the Celebrex.  A certain name brand has to have certain amount of deaths before it gets pulled off the market.

[Inch]

Has anyone taking statins (I've been on Zocor, 30mg for well over a year) had problems with thinning hair?  I've been doing a lot of reading on statins and have seen a few mentions of hair loss.  I'm considering stopping the meds because aside from Tenormin which I have taken for about 10 years for high blood pressure, I can find no other reason for losing my hair.  I've had blood tests to rule out other possiblilities, even my dermatologist doesn't understand this.  Any information would be greatly appreciated!!!!!! I am female and this is very distressing to me.

[xs1209]

Hi - I had a reaction to Zetia and lost my eyebrows and the hair on my forearms.  I found some information stating that was a rare side-effect of the drug.  I stopped taking Zetia and  changed to Crestor and have had no problems.

[Barbarella]

Hair loss can also come from hormonal imbalances i.e. pregnancy or menopause or from a thyroid disorder or even from stress.