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With seven statins on the market, you might wonder why your doctor chose a particular one for you. While all statins work the same way and reduce heart disease risk, they differ in important ways: how much they lower cholesterol, how they interact with other medications, when you should take them, and more.
Understanding these differences won't change which statin you take—that's your doctor's decision based on your complete medical picture—but it can help you understand why your medication was chosen and how to take it effectively.
The Seven Statins at a Glance
| Statin | Max Intensity | Best Timing | Drug Interactions |
|---|---|---|---|
| RosuvastatinCrestor | High | Any time | Fewer |
| AtorvastatinLipitor | High | Any time | More (CYP3A4) |
| SimvastatinZocor | Moderate | Evening | More (CYP3A4) |
| PravastatinPravachol | Moderate | Any time | Fewest |
| LovastatinMevacor | Moderate | With dinner | More (CYP3A4) |
| FluvastatinLescol | Moderate | Evening | Fewer |
| PitavastatinLivalo | Moderate | Any time | Fewer |
Potency: Not All Statins Are Created Equal
The most obvious difference between statins is how much they lower LDL cholesterol. Research from the VOYAGER meta-analysis, which pooled data from over 32,000 patients, established clear equivalencies:
Relative Potency
On a milligram-for-milligram basis, rosuvastatin is about 3 times more potent than atorvastatin, which is about twice as potent as simvastatin. For example, rosuvastatin 10 mg produces roughly the same LDL reduction as atorvastatin 30 mg or simvastatin 70 mg.
This is why only rosuvastatin and atorvastatin at higher doses qualify as "high-intensity" statins—meaning they can lower LDL by 50% or more. For patients who need the most aggressive cholesterol lowering (like those with prior heart attacks), these are typically the go-to choices.
But here's what matters more: when used at equivalent intensities, all statins reduce heart attacks and strokes by similar amounts. A moderate-intensity statin like simvastatin 40 mg and atorvastatin 10 mg provide comparable heart protection. The goal is matching the right intensity to your risk level, not necessarily using the "strongest" statin.
Drug Interactions: A Critical Difference
Perhaps the most clinically important distinction between statins is how they interact with other medications. Simvastatin, atorvastatin, and lovastatin are all processed by a liver enzyme called CYP3A4, which also handles many other common medications.
Medications That Can Increase Statin Levels
When taken with CYP3A4-metabolized statins, these can raise statin blood levels and increase side effect risk:
- • Certain antibiotics (clarithromycin, erythromycin)
- • Antifungals (ketoconazole, itraconazole)
- • HIV protease inhibitors
- • Calcium channel blockers (diltiazem, verapamil)
- • Grapefruit juice (in large amounts)
Pravastatin and rosuvastatin have a major advantage here—they're not significantly metabolized by CYP3A4, so they have fewer drug interactions. If you take multiple medications, these may be safer choices.
When Should You Take Your Statin?
Your body makes most of its cholesterol at night, so some statins work better when taken in the evening. However, this depends on how long the statin stays active in your body:
Take Any Time
Atorvastatin, rosuvastatin, pitavastatin, pravastatin
These have long half-lives and stay active for 24+ hours
Evening/With Dinner
Simvastatin, fluvastatin, lovastatin
These have shorter half-lives and work best when taken at night
The most important thing isn't when you take your statin—it's that you take it consistently. If evening dosing is hard to remember, a statin that can be taken any time might be a better fit.
Good News: Cost Is Rarely a Barrier
All the commonly used statins—atorvastatin, simvastatin, pravastatin, lovastatin, and rosuvastatin—are available as inexpensive generics. Many pharmacies offer them for as little as $4-10 for a month's supply, and most insurance plans cover them with minimal copays.
The Bottom Line
The "best" statin is the one that gets your cholesterol to goal while fitting into your life and your other medications. For most people, the specific statin matters less than taking it consistently. Your doctor considers your cardiovascular risk, other medications, potential for side effects, and practical factors like dosing schedule when choosing your statin. If you're curious why you're on a particular one—ask!