Background

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.

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.

This report on prescription drugs to treat high cholesterol is part of a Consumer Reports project to help you find safe, effective medicines that give you the most value for your healthcare dollar. To learn more about the project and other drugs we’ve evaluated, go to CRBestBuyDrugs.org.

This information is produced by Consumer Reports and Consumer Reports Best Buy Drugs, a public information project supported by grants from the States Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin.

Do You Need a Statin?

Some people can lower their cholesterol by exercising and eating less saturated fat. Saturated fat is in meat, dairy products, bakery goods, and many snack foods. For other people, exercising and eating a healthier diet is not enough. They need to take a statin.

Before you start a statin, you and your doctor should look at your LDL cholesterol and your other risks for heart disease. These risks include smoking; obesity; lack of exercise; and having diabetes, high blood pressure, coronary artery disease, or a family history of heart disease.

Your doctor might prescribe a statin if blood tests determine that you have high LDL cholesterol (above 160 mg/dL for some; 130 mg/dL for others) or low HDL cholesterol (below 40 mg/dL for most people), and if diet and exercise changes fail or are unlikely to bring your LDL level down to an acceptable level.

What Should Your Cholesterol Levels Be?

If Your Total Cholesterol Level Is:

This Is Considered:

Less than 200 mg/dL

Desirable

200–239 mg/dL

Borderline

240 mg/dL and above

High

If Your LDL Cholesterol Level Is:

This Is Considered:

Less than 100 mg/dL

Optimal

100–129 mg/dL

Near optimal/above optimal

130–159 mg/dL

Borderline high

160–189 mg/dL

High

190 mg/dL and above

Very high

If Your HDL Cholesterol Level Is:

This Is Considered:

Less than 40 mg/dL

Low, increases risk

41–59 mg/dL

OK, but less than optimal

60 mg/dL and above

Good, helps lower risk

This table applies primarily to people with no other risk factors for heart disease.

Source: Adapted from the National Cholesterol Education Program, High Blood Cholesterol – What You Need to Know, revised June 2005. NIH Publication No. 05-3290.

Our Recommendations

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 drugstore’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 lives—so the cost can be an important factor to consider.

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.

This information was updated March 2012.

Cost and Effectiveness 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.

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

Generic Name and 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 10 mg

Generic

$111

34%–38%

Atorvastatin 20 mg

Generic

$153

42%–46%

Atorvastatin 10 mg

Lipitor

$139

34%–38%

Atorvastatin 20 mg

Lipitor

$191

42%–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%–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

18%–25%

Pravastatin 20 mg

Pravachol

$151

23%–29%

Pravastatin 40 mg

Pravachol

$207

26%–34%

Pravastatin 10 mg

Generic

$34

18%–25%

Pravastatin 20 mg

Generic

$32

23%–29%

Pravastatin 40 mg

Generic

$47

26%–34%

Rosuvastatin

Yes

Likely

Rosuvastatin 5 mg

Crestor

$176

39%–46%

Simvastatin

Yes

Yes

Simvastatin 10 mg

Zocor

$114

26%–33%

Simvastatin 20 mg

Zocor

$201

30%–40%

Simvastatin 10 mg

Generic

$39

26%–33%

Simvastatin 20 mg

Generic

$69

30%–40%

Statin Choices for Higher Risk People

Generic Name and 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%–46%

Atorvastatin 40 mg

Generic

$157

47%–51%

Atorvastatin 80 mg

Generic

$160

46%–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

Likely4

Lovastatin 80 mg5

Generic

$108

39%–48%

Lovastatin 40 mg sustained-release tablet

Altoprev

$507

40%

Pravastatin

Yes

Yes

Pravastatin 80 mg

Pravachol

$207

30%–37%

Pravastatin 80 mg

Generic

$72

30%–37%

Rosuvastatin

Yes

Likely

Rosuvastatin 10 mg

Crestor

$174

43%–50%

Rosuvastatin 20 mg

Crestor

$176

52%–55%

Rosuvastatin 40 mg

Crestor

$174

55%–60%

Simvastatin

Yes

Yes

Simvastatin 20 mg

Zocor

$201

30%–40%

Simvastatin 40 mg

Zocor

$198

35%–45%

Simvastatin 80 mg

Zocor

$206

Simvastatin 20 mg

Generic

$69

30%–40%

Simvastatin 40 mg

Generic

$69

35%–45%

Simvastatin 80 mg

Generic

$63

40%–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%–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 Symphony Health Solutions, which is not involved in our analysis or recommendations.

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

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

5. Requires taking two 40-mg tablets.

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.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health care professional. Consumer Reports is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, non-commercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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