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Anticholesterol Drug/Lipid Lowering Drug /Statins Groups Drug

Anticholesterol drug is also known as HMG-CoA reductase inhibitors, are a class of lipid-lowering medications. Statins have been found to reduce cardiovascular disease (CVD) and mortality in those who are at high risk of cardiovascular disease. The evidence is strong that statins are effective for treating CVD in the early stages of the disease (secondary prevention) and in those at elevated risk but without CVD (primary prevention)

The statins are divided into two groups: fermentation-derived and synthetic. They include, along with brand names, which may vary between countries:

Statin	Brand name	Derivation	Metabolism
Atorvastatin	Lipitor, Ator	Synthetic	CYP3A4
Cerivastatin	Lipobay, Baycol (withdrawn from the market in August, 2001 due to risk of serious rhabdomyolysis)	Synthetic	various CYP3Aisoforms
Fluvastatin	Lescol, Lescol XL	Synthetic	CYP2C9
Lovastatin	Mevacor, Altocor, Altoprev	Naturally occurring, fermentation-derived compound. It is found in oyster mushroomsand red yeast rice	CYP3A4
Mevastatin	Compactin	Naturally occurring compound found in red yeast rice	CYP3A4
Pitavastatin	Livalo, Livazo, Pitava	Synthetic	CYP2C9 and CYP2C8(minimally)
Pravastatin	Pravachol, Selektine, Lipostat	Fermentation-derived (a fermentation product of bacterium Nocardia autotrophica)	Non-CYP
Rosuvastatin	Crestor	Synthetic	CYP2C9 and CYP2C19
Simvastatin	Zocor, Lipex	Fermentation-derived (simvastatin is a synthetic derivate of a fermentation product of Aspergillus terreus)	CYP3A4
Simvastatin + ezetimibe	Vytorin, Inegy	Combination therapy: statin + cholesterol absorption inhibitor
Lovastatin + niacin extended-release	Advicor, Mevacor	Combination therapy
Atorvastatin + amlodipine	Caduet, Envacar	Combination therapy: statin + calcium antagonist
Simvastatin + niacin extended-release	Simcor	Combination therapy

LDL-lowering potency varies between agents. Cerivastatin is the most potent, (withdrawn from the market in August 2001 due to the risk of serious rhabdomyolysis) followed by (in order of decreasing potency), rosuvastatin, atorvastatin, simvastatin, lovastatin, pravastatin, and fluvastatin. The relative potency of pitavastatin has not yet been fully established.

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The oyster mushroom, a culinary mushroom, naturally contains lovastatin.

Some types of statins are naturally occurring and can be found in such foods as oyster mushrooms and red yeast rice. Randomized controlled trials have found these foodstuffs to reduce circulating cholesterol, but the quality of the trials has been judged to be low. Due to patent expiration, most of the block-buster branded statins have been generic since 2012, including atorvastatin, the largest-selling branded drug.

Statin equivalent dosages
% LDL reduction (approx.)	Atorvastatin	Fluvastatin	Lovastatin	Pravastatin	Rosuvastatin	Simvastatin
10–20%	–	20 mg	10 mg	10 mg	–	5 mg
20–30%	–	40 mg	20 mg	20 mg	–	10 mg
30–40%	10 mg	80 mg	40 mg	40 mg	5 mg	20 mg
40–45%	20 mg	–	80 mg	80 mg	5–10 mg	40 mg
46–50%	40 mg	–	–	–	10–20 mg	80 mg*
50–55%	80 mg	–	–	–	20 mg	–
56–60%	–	–	–	–	40 mg	–
* 80-mg dose no longer recommended due to increased risk of rhabdomyolysis
Starting dose
Starting dose	10–20 mg	20 mg	10–20 mg	40 mg	10 mg; 5 mg if hypothyroid, >65 yo, Asian	20 mg
If higher LDL reduction goal	40 mg if >45%	40 mg if >25%	20 mg if >20%	—	20 mg if LDL >190 mg/dL (4.87 mmol/L)	40 mg if >45%
Optimal timing	Anytime	Evening	With evening meals	Anytime	Anytime	Evening