Statins are the most widely prescribed class of drugs in the United States, with over 255 million prescriptions per year. Lipitor (atorvasatin) is the best-selling drug in the category, with sales of $7.2 billion annually. Crestor (rosuvastatin) has $3.8 billion in annual sales and is the 8th best-selling drug in the category. Zocor (simvastatin) has been sold as a generic since 2006, and over 2 million Americans take it. Statins were developed to decrease the body’s production of cholesterol. This article is an overview of some of the questions patients should ask their doctor.

What is the correct dose of a statin?

In June 2011, the FDA said that high dose Zocor (80 mg/day) should no longer be prescribed because of an increased risk of severe muscle disease within the first year. In January 2010, the VA reported that giving standard, fixed doses of a statin (Zocor 40 mg daily for low risk patients, and Lipitor 40 mg daily for high risk patients) was as effective as higher doses in achieving the lowest possible LDL (“bad” cholesterol) level. Lower dosage has fewer side effects and lower cost for patients. However, there is evidence in the medical literature that high dose therapy soon after a heart attack does decrease mortality.

Which is the correct statin?

In December 2011, researchers at The Cleveland Clinic reported that both high dose Lipitor (80 mg/day) and high dose Crestor (40 mg/day) had the same 1% decrease in the amount of plaque (obstruction) in coronary arteries even though Crestor lowered the LDL (“bad” cholesterol) more than Lipitor. Also, there was no difference between them in the frequency of cardiovascular events such as death (0.3%), heart attack (1.6%), or stroke (0.3%).

How many people have significant side effects with statins?

In this country, only 50% of those who would theoretically benefit from taking statins do so. In addition, up to 60% of patients who start taking statins stop within 2 years. Key reasons for stopping are muscular symptoms, fatigue, and shortness of breath. Since there is no consensus on the definition of these symptoms, statin intolerance is much lower in research trials (1-2%) than in clinical practice (20% or more). In clinical practice, complaints such as heaviness, stiffness, cramps are common, though blood tests (such as CK levels and liver function tests) are rarely positive.

When can I stop taking statins?

There is no consensus on this issue in the medical community. Almost none of the research studies include patients over the age of 75. A relative risk reduction in mortality at 5 years was 12%. This means that one death per year was avoided for every 417 patients taking a statin. The best approach to controlling high cholesterol is through diet and exercise as discussed by Dr. Sinsheimer, but in some cases statins are indicated. It is important to educate yourself on these medications and to have open dialogue with your physician when starting a program to manage your condition.

Dr. Thomas Reynolds is a board-certified internist and oncologist. His practice focuses on integrative and comprehensive medical care, particularly for older adults. Dr. Reynolds can be reached at 760.773.3200