Statin Dose for 30% to 40% LDL-Cholesterol Reduction
LDL-C reduction (%)
LDL-C = low density lipoprotein cholesterol; mg = milligram
Dose for dose, some statins are more powerful at lowering bad cholesterol than others. A standard dose generally refers to the amount that will lower LDL cholesterol by 30% to 40% (see table above). Which statin is best for you will depend on your cholesterol levels and your overall risk of having a heart attack or dying from heart disease. Cholesterol-lowering drugs are not a substitute for a healthy lifestyle; you must continue to eat a heart-healthy diet, exercise, and stop smoking (if you smoke) while taking your medication.
One study that directly compared four statins found that rosuvastatin (Crestor) reduced LDL cholesterol and total cholesterol more than atorvastatin, simvastatin, or pravastatin.26 There are safety concerns with the more powerful statins. Dose for dose, rosuvastatin is two to four times more potent than atorvastatin (the next most potent statin).27
Are very high doses of statins better than regular doses?
Some experts believe “the lower, the better” for LDL (bad) cholesterol. With this in mind, studies have compared high doses of statins (80 mg atorvastatin or simvastatin) with regular doses (40 mg pravastatin or simvastatin) in men and women who suffered a heart attack or who have been diagnosed with heart disease. In women who had a heart attack, taking a high dose statin within 10 days reduced the risk of future heart problems such as heart attack or stroke compared with regular doses, but did not reduce the risk of dying.28, 29 Women taking high dose statins suffered more side effects, including liver and muscle problems, than the women who took lower doses. Similar results were seen for men and women with stable heart disease who took either regular dose (10 mg) or high dose (80 mg) atorvastatin.30
Because of the risk of side effects, women should only take high dose statins if regular doses (and lifestyle changes) do not lower their LDL cholesterol enough. If you are hospitalized for a heart attack, you may be given high dose therapy right away.
Why do I have to take another cholesterol-lowering medication in addition to a statin?
Your doctor may prescribe another cholesterol medication ( fibrates, bile acid resins, ezetimibe [link to each]) or a diet that includes plant sterols and stanols in addition to a lower dose statin. This combination can lower LDL cholesterol by as much as 30% to 40%.19 Doubling the statin dose reduces LDL cholesterol by an extra 6% to 9%,31 and the risk of side effects increases with higher doses of statins.32 Some combinations of cholesterol-lowering medications, particularly statin-fibrate therapy (notably gemfibrozil [Lopid]) have a higher risk of muscle problems compared with a statin alone. Statins increase HDL (good) cholesterol levels by a small amount. If your HDL cholesterol is low, your doctor may prescribe an additional medication, usually niacin, as well as a statin.