Consumer Reports Health

Statins: Summary of Recommendations

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The cholesterol-lowering medicines known as statins lower the chances of a heart attack and death in people who have an elevated risk of developing heart disease or who already have heart disease.

There are seven statins, but they're not all the same. Some deliver a greater reduction in cholesterol than others. In addition, some statins are backed by stronger evidence that they reduce the risk of a heart attack or death from heart disease or a stroke.

Statins can vary widely in cost as well—from as little as $12 per month (and even less if your drug is available on a drug store's discount generic list) to more than $500. Most people who take them must continue to do so for years—perhaps for the rest of their life—so the cost can be an important factor to consider.

Your individual circumstances, such as how much you need to lower your cholesterol and whether you have heart disease or have had a heart attack, should also be considered when looking at your options. Certain statins are better depending on your health status.

Taking the evidence for effectiveness, safety, and cost into account, we have chosen four statins as Consumer Reports Best Buy Drugs:

Generic lovastatin or pravastatin—if you need to lower "bad" (LDL) cholesterol by less than 30 percent.
Generic simvastatin (20 mg or 40 mg)—if you need an LDL reduction of 30 percent or more and/or have heart disease or diabetes, or if you've had a heart attack or have acute coronary syndrome and your LDL level is not highly elevated.
Generic atorvastatin (40 mg or 80 mg)—if you have had a heart attack or have acute coronary syndrome and your LDL is highly elevated.

Most people who need a statin should take the lowest dose that reduces their LDL cholesterol to an acceptable "target" level, because higher doses pose a greater risk of serious side effects, such as muscle, kidney, and liver problems. But some people—such as those who have had a heart attack—may require a higher dose.

No matter what dose you take, if you experience muscle aches and pains when taking a statin, contact your doctor immediately. Also ask him or her about splitting your statin pills. This can save you money and is a widely accepted practice.

Statins for High Cholesterol, Heart Disease: Drug Comparison

Note: If the price box contains a

, that indicates the dose of that drug is likely available for a low monthly cost through programs offered by large chain stores. For example, Kroger, Sam's Club, Target, and Walmart offer a month's supply of selected generic drugs for $4 or a three-month supply for $10. Other chain stores, such as Costco, CVS, Kmart, and Walgreens, offer similar programs. Some programs have restrictions or membership fees, so check the details carefully for restrictions and to make sure your drug is covered.

CR Best Buy	Statin Choices for People Who Require LDL Lowering of Less than 30%
CR Best Buy	Generic Name and Dose Per Day	Brand Name¹	Average Monthly Cost²	Average Expected LDL Reduction	Reduces the Risk of Heart Attack?³	Mortality Reduction?
	Atorvastatin				Yes	Yes
	Atorvastatin 10 mg	Generic	$111	34% to 38%
	Atorvastatin 20 mg	Generic	$153	42% to 46%
	Atorvastatin 10 mg	Lipitor	$139	34% to 38%
	Atorvastatin 20 mg	Lipitor	$191	42% to 46%
	Fluvastatin				Likely	Likely
	Fluvastatin 20 mg	Lescol	$144	22%
	Fluvastatin 40 mg	Lescol	$141	25%
	Lovastatin				Yes	Likely⁴
	Lovastatin 10 mg	Generic	$12	21%
	Lovastatin 20 mg	Generic	$20	24% to 27%
	Lovastatin 40 mg	Generic	$54	31%
	Lovastatin 20 mg sustained-release tablet	Altoprev	$460	30%	Unknown	Unknown
	Lovastatin 40 mg sustained-release tablet	Altoprev	$510	36%
	Pravastatin				Yes	Yes
	Pravastatin 10 mg	Pravachol	$149	23% to 29%
	Pravastatin 20 mg	Pravachol	$151	23% to 29%
	Pravastatin 40 mg	Pravachol	$207	26% to 34%
	Pravastatin 10 mg	Generic	$34	18% to 25%
	Pravastatin 20 mg	Generic	$32	23% to 29%
	Pravastatin 40 mg	Generic	$47	26% to 34%
	Rosuvastatin				Yes	Likely
	Rosuvastatin 5 mg	Crestor	$176	39% to 46%
	Simvastatin				Yes	Yes
	Simvastatin 10 mg	Zocor	$114	26% to 33%
	Simvastatin 20 mg	Zocor	$201	30% to 40%
	Simvastatin 10 mg	Generic	$39	26% to 33%
	Simvastatin 20 mg	Generic	$69	30% to 40%

Statin Choices for People Who Require LDL Lowering of More than 30 percent

Note: If the price box contains a

CR Best Buy	Statin Choices for Higher Risk People (Requiring LDL reduction of 30% or greater)
CR Best Buy	Generic Name With Dose per Day	Brand Name¹	Average Monthly Cost ²	Average Expected LDL Reduction	Reduces the Risk of Heart Attack?³	Mortality Reduction?
	Atorvastatin				Yes	Yes
	Atorvastatin 20 mg	Generic	$153	42% to 46%
	Atorvastatin 40 mg	Generic	$157	47% to 51%
	Atorvastatin 80 mg	Generic	$160	46% to 54%
	Atorvastatin 20 mg	Lipitor	$191	42%-46%
	Atorvastatin 40 mg	Lipitor	$199	47%-51%
	Atorvastatin 80 mg	Lipitor	$209	46%-54%
	Fluvastatin				Likely	Likely
	Fluvastatin sustained-release 80 mg	Lescol XL	$189	35%
	Lovastatin				Yes	Likely⁵
	Lovastatin 80 mg⁴	Generic	$108	39% to 48%
	Lovastatin sustained-release 60 mg	Altoprev	$507	40%
	Pravastatin				Yes	Yes
	Pravastatin 80 mg	Pravachol	$207	30% to 37%
	Pravastatin 80 mg	Generic	$72	30% to 37%
	Rosuvastatin				Yes	Likely
	Rosuvastatin 10 mg	Crestor	$174	43% to 50%
	Rosuvastatin 20 mg	Crestor	$176	52% to 55%
	Rosuvastatin 40 mg	Crestor	$174	55% to 60%
	Simvastatin				Yes	Yes
	Simvastatin 20 mg	Zocor	$201	30% to 40%
	Simvastatin 40 mg	Zocor	$198	35% to 45%
	Simvastatin 80 mg	Zocor	$206	40% to 50%
	Simvastatin 20 mg	Generic	$69	30% to 40%
	Simvastatin 40 mg	Generic	$69	35% to 45%
	Simvastatin 80 mg	Generic	$63	40% to 50%
	Ezetimibe/simvastatin⁶				No	No
	Ezetimibe/simvastatin 10 mg/10 mg	Vytorin	$157	46%
	Ezetimibe/simvastatin 10 mg/20 mg, 10 mg/40 mg, or 10 mg/80 mg	Vytorin	$153-$156	31% to 53%

(1) "Generic" indicates a drug sold by generic name.

(2) Prices reflect nationwide retail average for February 2012, rounded to nearest dollar. Information derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Pharma Solutions, which is not involved in our analysis or recommendations.

(3) Nonfatal and fatal heart attack plus deaths attributed to heart disease.

(4) Requires taking two 40 mg tablets.

(5) Lovastatin has not been proven to reduce deaths but the evidence strongly points in that direction.

(6) Two studies cast doubt on the benefits of this drug. The first was a two-year study that found that Vytorin was no better than simvastatin alone in reducing plaque buildup in arteries. The second was a five-year study that found that Vytorin did not reduce heart attacks or strokes compared to placebo.

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