Are there different types of statins?

• Statins are a group of medications used to lower cholesterol. There are 7 types available: Atorvastatin (Lipitor), Rosuvastatin (Crestor), Simvastatin (Zocor), Lovastatin (Mevacor), Pravastatin (Pravachol), Fluvastatin (Lescol), Pitavastatin (Zypitamag, Livalo).
• Different statins have different strengths, interact differently with other medications and foods (grapefruit), have different dosing schedules.
• Statins are classified into high, moderate, and low intensity depending on how much they lower LDL cholesterol. High-intensity statins lower LDL the most and are often for those with very high LDL or a history of heart issues.
• Not all statins are equally effective at lowering LDL, but the best one for you depends on your cholesterol levels, risk factors, and how well you tolerate it.
• Common side effects include muscle pain and digestive issues, while serious side effects are rare but possible.

Statins are a group of medications used to lower cholesterol. Cholesterol is a fatty substance that your body needs in small amounts, but too much of it can clog arteries and increase the risk of heart attack and stroke. Statins work by blocking a liver enzyme called HMG-CoA reductase, which plays a key role in cholesterol production. By slowing this process down, statins help lower LDL-C or "bad cholesterol".

According to the CDC, nearly 2 in 5 adults in the U.S. have high cholesterol, often without knowing it. Statins lower LDL-C and reduce your risk of heart attack and stroke by 25% to 35%.

In addition to lowering LDL, statins can also raise HDL, or “good cholesterol,” and reduce triglycerides, another type of fat in your blood. Because of these benefits, statins remain the most commonly prescribed medications for heart health.

Read Important Cholesterol Markers You Should Know About

Types of Statins

There are 7 statins and they differ in their potency, dosing schedule, and how they interact with other medications and foods. Some factors that may set them apart include the following:

• Strength: High-intensity statins, including atorvastatin and rosuvastatin, lower LDL the most.
• Drug interactions: Some statins, such as simvastatin and lovastatin, interact with grapefruit and certain medications, while others, such as pravastatin and pitavastatin, have fewer interactions.
• Dosing schedule: Some statins (simvastatin, lovastatin, fluvastatin) are best taken in the evening, while others (atorvastatin, rosuvastatin, pitavastatin) can be taken at any time of day.
• Tolerability: Some patients tolerate certain statins better than others. If one statin causes muscle pain or other side effects, switching to a different one may help.

Statin Intensity and LDL Reduction

Statins are classified into 3 intensity levels based on their LDL-C reduction capabilities:

• High intensity: More than 50% reduction. Prescribed for patients with very high LDL levels or a history of heart attack or stroke.
• Moderate intensity: 30%-49% reduction. For patients who need cholesterol control but do not require the strongest option.
• Low intensity: Less than 30% reduction. Less commonly prescribed but may be an option for patients who cannot tolerate higher doses.

Some statins lower LDL more than others, but this does not necessarily mean they are better. What matters most is choosing the right statin for you based on your cholesterol levels, risk factors, and tolerance.

With multiple statin options available, there is no one-size-fits-all approach. The best statin is the one that effectively lowers LDL while being well tolerated. If one statin causes side effects, another may be a better fit.

That’s why talking with your doctor about symptoms, medication interactions, and cholesterol goals can help determine the right choice for you.

Statin Side Effects

Statins are effective for lowering cholesterol, but as with any medication, they can cause side effects. Understanding what to watch for and when to contact your doctor can help you take them safely.

Common Side Effects

• Muscle pain, spasms, or weakness: This is one of the most common complaints. If you notice mild discomfort, try taking it at a different time of day or switching to another one. Coenzyme Q10 (CoQ10) supplements may help, though studies are mixed. If muscle pain is severe or persistent, contact your doctor.
• Joint pain: Some patients experience joint stiffness or discomfort. If this happens, your doctor may recommend a lower dose or switching to a different statin.
• Digestive issues: Nausea, bloating, or diarrhea can occur, especially when first starting. Taking statins with food may help. If these symptoms persist, let your doctor know.
• Mild headache or dizziness: This is usually temporary and improves as your body adjusts. Staying hydrated and taking your medication at bedtime may help.

Serious Side Effects

While uncommon, serious side effects require immediate attention. Contact your doctor right away if you experience any of the following:

• Severe muscle pain, weakness, or dark-colored urine: This may be a sign of rhabdomyolysis, a rare but serious condition where muscle breakdown releases proteins into your bloodstream, which can cause kidney damage.
• Yellowing of your skin or eyes, dark urine, or persistent nausea: These could indicate worsening liver problems or liver failure. Statins can raise liver enzymes in some patients, though serious liver damage is rare.
• High blood sugar or increased A1C levels: Some statins may cause a slight increase in blood sugar levels, which can be a concern for patients with diabetes or prediabetes. However, the benefits of statins in preventing heart disease generally outweigh this risk. If you have diabetes, your doctor may monitor your blood sugar levels more closely or adjust your medications if needed.
• Unexplained memory issues or confusion: Some patients have reported cognitive effects, though these symptoms are uncommon and usually reversible after stopping your statin.

Risks

Grapefruit: Grapefruit can affect how your body processes certain statins, especially simvastatin. It can cause higher drug levels in your bloodstream, increasing your risk of side effects such as muscle pain and rhabdomyolysis.

Alcohol: Excessive drinking can increase your risk of liver problems, especially since statins are processed in your liver. If you drink alcohol regularly, talk to your doctor about what is safe for you.

Pregnancy or breastfeeding: Statins should not be taken during pregnancy because they can interfere with fetal development. If you are planning to become pregnant, your doctor will likely recommend stopping statins beforehand.

If pregnancy occurs while taking a statin, your medication should be stopped immediately, and an alternative plan for managing cholesterol should be discussed.

Statins are also not recommended while breastfeeding, as they can pass into breast milk. If cholesterol management is needed during this time, your doctor may suggest alternative treatments.

Speak with Your Doctor

If you have concerns about statins, talk to your doctor about the best option for you. Whether you need a stronger statin, a lower dose, or an alternative medication, there are many ways to adjust treatment based on your needs. If side effects occur, your doctor can help determine whether a different statin or dosage change is necessary.

Regular check-ups and cholesterol tests will help track progress and make sure your statin is working effectively. If you take other medications, your doctor can also check for possible interactions.

Statins are one of the most researched and widely used medications for heart health. With the right approach, they can be both safe and effective. If you have any concerns or experience side effects, do not hesitate to ask your doctor about adjustments to find the best option for you.