Drug Class Guide
Statins
The most widely prescribed cholesterol medicines, and among the best-studied drugs for preventing heart attack and stroke.
How Statins Work
Statins block HMG-CoA reductase, the enzyme your liver uses to make cholesterol. The liver responds by pulling more LDL ("bad") cholesterol out of the blood. Lowering LDL slows the buildup of plaque in the arteries, which is why statins reduce heart attacks and strokes, not just a lab number.
What Statins Treat
Statins in Our Medication Guide
- AtorvastatinLipitorModerate or high intensity depending on the dose; one of the most prescribed drugs in the U.S.
- RosuvastatinCrestorAmong the most potent statins; moderate or high intensity depending on the dose.
- SimvastatinZocorModerate intensity; interacts with more drugs, including some antibiotics and antifungals.
- PravastatinPravacholLower to moderate intensity, with fewer drug interactions than most statins.
Common Side Effects
Most people take statins without trouble. Muscle aches are the most common complaint, although in blinded trials most muscle symptoms happened about as often with a placebo. Less often, statins raise liver enzymes or nudge blood sugar up slightly. Serious muscle breakdown is rare.
Important Cautions
- Report unexplained muscle pain or weakness with dark urine right away.
- Simvastatin and atorvastatin interact with large amounts of grapefruit juice and with several common medications.
- Tell your doctor if you are pregnant or planning a pregnancy; most people stop statins during pregnancy.
Common Questions About Statins
Which statin is the strongest?
Rosuvastatin and atorvastatin are the most potent. At higher doses both are high-intensity statins, which lower LDL cholesterol by roughly half or more. Simvastatin and pravastatin are milder. The right choice depends on how much your LDL needs to come down and on your other medications.
Do statins really cause muscle pain?
Sometimes, but less often than many people expect. In large blinded trials, most muscle aches reported on a statin also occurred with a placebo. If you have aches, your doctor may pause the statin, try a lower dose, or switch to a different one; most people find one they can take.
Do I have to take a statin forever?
The benefit lasts only as long as you take it; when a statin is stopped, LDL cholesterol returns to its earlier level within weeks. For most people with heart disease or high risk, statins are long-term medicines. Talk with your doctor before stopping.
This guide is general information, not a substitute for advice about your own medicines. Do not start, stop or switch a medication without talking with your doctor. Questions about a prescription? Our internal medicine team can help.
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Trusted Resources for Statins
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