Statins: Summary of Recommendations
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There are six statins and they differ in their ability to reduce cholesterol. In addition, the evidence is stronger for some statins when it comes to reducing your risk of heart attack or death from heart disease or stroke. Thus, the choice of the best statin for you can be complex.
The statins vary widely in cost as well — from about $32 a month to more than $150 a month. Most people who take a statin must take the medicine for years, so the cost matters.
Taking the evidence for effectiveness, safety, and cost into account, we have chosen four statins as Consumer Reports Best Buy Drugs:
- Generic lovastatin and pravastatin — if you need to lower "bad" (LDL) cholesterol by less than 30%
- 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. Generic pravastatin and simvastatin became available in 2006. The price of these two medicines will decline in 2007, creating a significant savings opportunity compared to brand-name statins.
Most people who need a statin should take the lowest dose that reduces their "bad" LDL cholesterol to an acceptable "target" level. High doses of statins pose greater risk — of muscle and liver problems. But some people – such as those who have had heart attacks — may need higher doses.
No matter what dose you take, if you have muscle aches and pains when taking a statin, contact your doctor immediately. Also ask your doctor about splitting your statin pills. This can save you money and is a widely accepted practice.
Statins for High Cholesterol, Heart Disease: Drug Comparison
| CR Best Buy | Statin Choices for People Who Require LDL Lowering of Less than 30% | ||||||
| Generic Name and Dose Per Day | Brand Name1 | Average Monthly Cost2 | Average Expected LDL Reduction | Reduces the Risk of Heart Attack?3 | Mortality Reduction? | Compare Prices | |
| Atorvastatin 10mg | Lipitor | $101 | 34%-38% | Yes | Yes |  |
|
| Atorvastatin 20mg | Lipitor | $145 | 42%-46% | Yes | Yes | |
|
| Ezetimibe/simvastatin 10mg/10mg | Vytorin | $122 | 45% | Yes4 | Yes4 | |
|
| Ezetimibe/simvastatin 10mg/20mg | Vytorin | $120 | 52% | Yes4 | Yes4 | |
|
| Fluvastatin 20mg | Lescol | $96 | 22% | Likely | Likely | |
|
| Fluvastatin 40mg | Lescol | $96 | 25% | Likely | Likely | |
|
 |
Lovastatin 10mg | Generic | $26 | 21% | Yes | Likely5 | |
|
Lovastatin 20mg | Generic | $18 | 24%-27% | Yes | Likely5 | |
|
Lovastatin 40mg | Generic | $48 | 31% | Yes | Likely5 | |
| Lovastatin 10mg | Mevacor | $52 | 21% | Yes | Likely5 | |
|
| Lovastatin 20mg | Mevacor | $86 | 24%-27% | Yes | Likely5 | |
|
| Lovastatin 40mg | Mevacor | $145 | 31% | Yes | Likely5 | |
|
| Lovastatin 20mg long-acting | Altoprev | $147 | 30% | Yes6 | Likely6 | |
|
| Lovastatin 40mg long-acting | Altoprev | $159 | 36% | Yes6 | Likely6 | |
|
|
Pravastatin 10mg | Generic | $20-607 | 18%-25% | Yes | Yes | |
|
Pravastatin 20mg | Generic | $20-607 | 23%-29% | Yes | Yes | |
|
Pravastatin 40mg | Generic | $40-1007 | 26%-34% | Yes | Yes | |
| Pravastatin 10mg | Pravachol | $125 | 18%-25% | Yes | Yes | |
|
| Pravastatin 20mg | Pravachol | $132 | 23%-29% | Yes | Yes | |
|
| Pravastatin 40mg | Pravachol | $197 | 26%-34% | Yes | Yes | |
|
| Rosuvastatin 5mg | Crestor | $129 | 39%-46% | Likely | Likely | |
|
| Simvastatin 10mg | Generic | $30-607 | 26%-33% | Yes | Yes | |
|
| Simvastatin 20mg | Generic | $30-607 | 30%- 40% | Yes | Yes | |
|
| Simvastatin 10mg | Zocor | $102 | 26%-33% | Yes | Yes | |
|
| Simvastatin 20mg | Zocor | $180 | 30%- 40% | Yes | Yes | |
|
(1) "Generic" indicates drug sold by generic name.
(2) Prices reflect nationwide retail average for January 2008, rounded to nearest dollar; information derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Health, Pharmaceutical Audit Suite®.
(3) Nonfatal and fatal heart attack plus deaths attributed to heart disease.
(4) The combination of these two drugs has not been proven effective but simvastatin alone has. The benefit is assumed for the combination.
(5) Lovastatin has not been proven to reduce deaths, but the evidence strongly points in that direction.
(6) Based on the results for shorter-acting versions of the drugs.
(7) The price ranges cited here for generic pravastatin and simvastatin reflect spot checks at internet pharmacies in the summer of 2008. They are not from Wolters Kluwer Health. The prices of these two reflectively new generic drugs have been declining since they became available in 2006. Some discount stores and pharmacy chains may offer them at a lower cost than we cite here.
(2) Prices reflect nationwide retail average for January 2008, rounded to nearest dollar; information derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Health, Pharmaceutical Audit Suite®.
(3) Nonfatal and fatal heart attack plus deaths attributed to heart disease.
(4) The combination of these two drugs has not been proven effective but simvastatin alone has. The benefit is assumed for the combination.
(5) Lovastatin has not been proven to reduce deaths, but the evidence strongly points in that direction.
(6) Based on the results for shorter-acting versions of the drugs.
(7) The price ranges cited here for generic pravastatin and simvastatin reflect spot checks at internet pharmacies in the summer of 2008. They are not from Wolters Kluwer Health. The prices of these two reflectively new generic drugs have been declining since they became available in 2006. Some discount stores and pharmacy chains may offer them at a lower cost than we cite here.
| CR Best Buy | Statin Choices for Higher Risk People (Requiring LDL reduction of 30% or greater) | |||||||
| 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? | Compare Prices | ||
| Atorvastatin 20mg | Lipitor | $145 | 42% to 46% | Yes | Yes | |
||
|
Atorvastatin 40mg | Lipitor | $146 | 47% to 51% | Yes | Yes | |
|
|
Atorvastatin 80mg | Lipitor | $147 | 46% to 54% | Yes | Yes | |
|
| Ezetimibe/simvastatin 10mg/10mg | Vytorin | $122 | 45% | Yes4 | Yes4 | |
||
| Ezetimibe/simvastatin 10mg/20mg | Vytorin | $120 | 52% | Yes4 | Yes4 | |
||
| Ezetimibe/simvastatin 10mg/40mg | Vytorin | $120 | 55% | Yes4 | Yes4 | |
||
| Ezetimibe/simvastatin 10mg/80mg | Vytorin | $118 | 60% | Yes4 | Yes4 | |
||
| Fluvastatin XL 80mg | Lescol XL | $123 | 35% | Likely | Likely | |
||
| Lovastatin 80mg5 | Generic | $96 | 39%-48% | Yes | Likely6 | |
||
| Lovastatin 60mg long-acting | Altoprev | $161 | 40% | Yes | Likely6 | |
||
| Pravastatin 80mg | Pravachol | $197 | 30%-37% | Yes | Yes | |
||
| Rosuvastatin 10mg | Crestor | $126 | 43%-50% | Likely | Likely | |
||
| Rosuvastatin 20mg | Crestor | $125 | 52%-55% | Likely | Likely | |
||
| Rosuvastatin 40mg | Crestor | $126 | 55%-60% | Likely | Likely | |
||
|
Simvastatin 20mg | Generic | $30-607 | 30%-40% | Yes | Yes | |
|
|
Simvastatin 40mg | Generic | $30-707 | 35%-45% | Yes | Yes | |
|
| Simvastatin 80mg | Generic | $45-757 | 40%-50% | Yes | Yes | |
||
| Simvastatin 20mg | Zocor | $180 | 30%-40% | Yes | Yes | |
||
| Simvastatin 40mg | Zocor | $184 | 35%-45% | Yes | Yes | |
||
| Simvastatin 80mg | Zocor | $183 | 40%-50% | Yes | Yes | |
||
(1) "Generic" indicates drug sold by generic name.
(2) Prices reflect nationwide retail average for January 2008, rounded to nearest dollar; information derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Health, Pharmaceutical Audit Suite®.
(3) Nonfatal and fatal heart attack plus deaths attributed to heart disease
(4) The combination of these two drugs has not been proven effective but simvastatin alone has. The benefit is assumed for the combination
(5) Requires taking two 40 mg tablets.
(6) Lovastatin has not been proven to reduce deaths, but the evidence strongly points in that direction.
(7) The price ranges cited here for generic simvastatin reflect a spot checks at internet pharmacies in the summer of 2008. They are not from Wolters Kluwer Health. The price of this relatively new generic drug has been declining since it became available in 2006. Some discount stores and pharmacy chains may offer simvastatin at a lower cost than we cite here.
(2) Prices reflect nationwide retail average for January 2008, rounded to nearest dollar; information derived by Consumer Reports Best Buy Drugs from data provided by Wolters Kluwer Health, Pharmaceutical Audit Suite®.
(3) Nonfatal and fatal heart attack plus deaths attributed to heart disease
(4) The combination of these two drugs has not been proven effective but simvastatin alone has. The benefit is assumed for the combination
(5) Requires taking two 40 mg tablets.
(6) Lovastatin has not been proven to reduce deaths, but the evidence strongly points in that direction.
(7) The price ranges cited here for generic simvastatin reflect a spot checks at internet pharmacies in the summer of 2008. They are not from Wolters Kluwer Health. The price of this relatively new generic drug has been declining since it became available in 2006. Some discount stores and pharmacy chains may offer simvastatin at a lower cost than we cite here.
Download- Full Report (379k PDF)
- 2-Page summary (236k PDF)
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