As in the total STELLAR population,19,20 rosuvastatin 1040mg reduced LDL-C and non-HDL-C more than milligram-equivalent doses of atorvastatin, and milligram-equivalent and higher doses of simvastatin and pravastatin. (2020). See statins in Asian patients for more. Learn about the types of statin medications, their differences, and the factors that may affect your doctor's recommendation. Although women have been under-represented in clinical end-point trials of statins, analyses of subgroups of women from these trials indicate that LDL-C reduction decreased cardiovascular event rates to a similar degree in women compared with that documented in men.14,16,25, A meta-analysis of 18 randomized controlled trials of statins in primary prevention found that statin intervention was associated with a lower cardiovascular event rate versus control and was similar in women and men (odds ratio [OR] 0.81, 95% CI: 0.750.89; p<0.0001 vs. OR 0.77, 95% CI: 0.710.83; p<0.0001, respectively).14 In addition, a sex-specific analysis of data from the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) study assessed the efficacy and safety of rosuvastatin in apparently healthy individuals with raised high-sensitivity C-reactive protein.25 Overall, the absolute CVD rates in women for rosuvastatin and placebo (0.57 and 1.04, respectively) were lower than those in men (0.88 and 1.54, respectively), although the relative risk reduction associated with rosuvastatin was similar in women and men (hazard ratio [HR] 0.54, 95% CI: 0.370.80; p=0.002 vs. HR 0.58, 95% CI: 0.450.73; p<0.001).25, Another meta-analysis compared the effect of statins in secondary prevention of CVD in men and women in 11 trials.16 Statin therapy (atorvastatin, fluvastatin, lovastatin, pravastatin, or simvastatin) was shown to be associated with a reduced risk of cardiovascular events in all outcomes for women (risk ratio [RR] 0.81, 95% CI 0.740.89) and men (RR 0.82, 95% CI 0.780.85). Am J Cardiol. Conclusions: Statin therapies in the STELLAR trial led to reductions in LDL-C, non-HDL-C, and triglycerides and increases in HDL-C among hypercholesterolemic women, with rosuvastatin providing the greatest reductions in LDL-C and non-HDL-C. Cardiovascular disease (CVD) is the leading cause of mortality among women in the United States.1 While coronary heart disease (CHD) rates in women increase markedly with age,2,3 of particular concern is the increasing number of CHD deaths among US women aged 3554 years, believed to be due to the increasing prevalence of obesity.4 Therefore, early identification and aggressive management of modifiable risk factors are essential to reduce the overall burden of CHD in women.5. Coronary heart disease (CHD) affects an estimated 13.2 million persons in the United States, and is the single largest cause of death among both men and women, accounting for 1 of 5 US deaths in 2003.1 Low-density lipoprotein cholesterol (LDL-C) is an important risk factor for CHD; randomized controlled trials have demonstrated that lowering LDL-C reduces the risk for major coronary events. Statins are a class of drugs that lower LDL, or bad, cholesterol levels in the body by preventing production in the liver, where the majority of the bodys cholesterol is produced. Treating patients with documented atherosclerosis to National Cholesterol Education Program-recommended low density-lipoprotein cholesterol goals with atorvastatin, fluvastatin, lovastatin and simvastatin. Schrott HG, Bittner V, Vittinghoff E, Herrington DM, Hulley S. Adherence to National Cholesterol Education Program Treatment goals in postmenopausal women with heart disease. For purposes of this study, simvastatin doses of 20, 40, and 80 mg were considered therapeutically equivalent to atorvastatin doses of 10, 20, and 40 mg. Because the maximum recommended dosage of simvastatin is 80 mg/day, there is no simvastatin dose equivalent to atorvastatin 80 mg. We conducted a retrospective, patient-level analysis of pharmacy claims for patients with an atorvastatin prescription dispensed in September 2005, the index month. Reductions in non-HDL-C levels ranged from 45% to 53% with rosuvastatin, 37% to 48% with atorvastatin, 27% to 44% with simvastatin, and 19% to 28% with pravastatin (Fig. 19. In addition to statin-only drugs, some drugs include a statin in combination with another drug. Careers, Unable to load your collection due to an error. You can learn more about how we ensure our content is accurate and current by reading our. An HDL cholesterol level above 60 protects against heart disease. In high-risk patients with hypercholesterolemia, rosuvastatin 10 mg was more efficacious than atorvastatin 20 mg at reducing LDL-C, enabling LDL-C goal achievement and improving other lipid parameters. The tour begins on Aug. 3 in Sterling . Circulation. The tablet may be taken without regard to food. Your doctor may adjust your dose as needed. What is the lowest mg for statins? It's effective for up to 36 hours. Although switching from more expensive brand name drugs to generic equivalents may reduce aggregate prescription costs, therapeutic benefit may be compromised if the patient is not switched to a drug with an equivalent therapeutic profile. Having high triglycerides but low cholesterol can result from factors such as diet, medications, and larger health problems. Heart Disease and Stroke Statistics 2022 Update: A Report from the American Heart Association. 2000;5:27-32. LDL-C, low-density lipoprotein cholesterol. 13. The percent of switches to a lower therapeutic dose was 18% for those switching from 10 mg, 43% for those switching from 20 mg, 73% for those switching from 40 mg, and 100% for those switching from 80 mg. Standard risk stratification tools, such as the Framingham risk score, are limited in that they focus on short-term (i.e., 10-year) risk of myocardial infarction and CHD death only, exclude family history, and overestimate or underestimate risk in non-white populations. Farnier M, Portal JJ, Maigret P. Efficacy of atorvastatin compared with simvastatin in patients with hypercholesterolemia. Note that if a patient switched to more than 1 dose level of branded simvastatin during the study period, the patient was counted in each of the dose levels of branded simvastatin prescribed. 2002;84:53-57. If you're taking diabetes drugs, herbs or supplements, your dosage might need to be adjusted . Cyclosporine raises atorvastatin levels and may increase the risk of toxicity. Dose Conversion Table for Statins: Title: Microsoft Word - Lipids dose conversion . Pharmacists Rock At Saving Lives and Preventing Flu Pitavastatin 2 mg Rosuvastatin 5 mg Atorvastatin 10 mg Simvastatin 20 mg Lovastatin 40 mg Pravastatin 40 mg Fluvastatin 80 mg. Big CYP inducers. Statins usually take 24 weeks to become fully effective, including after dosage changes. Gutierrez J, Ramirez G, Rundek T, Sacco RL. Circulation. Results: LDL-C reduction with rosuvastatin 10mg, atorvastatin 10mg, simvastatin 20mg, and pravastatin 40mg was 49%, 39%, 37%, and 30%, respectively, after 6 weeks. Patients switching to a specific dose of branded simvastatin from a specific dose of atorvastatin: The count of unique patients who switched from a specific dose of atorvastatin at index to a specific dose of branded simvastatin within 12 months of the index period. 2001;17:43-50. (2023). For example, if your cholesterol levels do not respond as they should to treatment with just a statin, your doctor may have you take a drug that combines a statin with ezetimibe. A number of randomized studies have compared the effects on LDL-C of atorvastatin versus simvastatin at various dose levels.6-19 These studies differ in design (open-label or double-blind; parallel-group or crossover), numbers of patients randomized to atorvastatin versus simvastatin (range, <100 to >1700), treatment duration (range, 6-54 weeks), patient characteristics (mean baseline LDL-C levels ranging from approximately 172.5-346 mg/dL), and dosing regimens (fixed-dose, dose escalation, or titration to target). 3. They may be able to adjust your dosage, switch you to another statin, or stop your statin therapy to give you a different cholesterol-lowering medication. Lowering cholesterol isnt the only benefit associated with statins. 2002;89:667-671. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Label:Fluvastatin sodium ER- fluvastatin sodium tablet, extended release. Your doctor also needs to know the other medications you take to recommend a statin for you. Each patient in the database is assigned a unique synthetic identification number allowing for the longitudinal tracking of the claims per patient over time. If your doctor recommends statin therapy, they will work with you to choose an appropriate statin that accounts for factors like any underlying health conditions, other medications you may be taking, your age, and your tolerance of statins. Am J Cardiol. With secondary prevention, the drugs are used to prevent the recurrence of heart attack or stroke. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. J Am Coll Cardiol. Black Zone - Brands that have dose equivalent generics available - WILL require patient to try a generic before covered Dark Gray Zone - Brands that have only high-dose generic alternative available - WILL NOT require patient to try a generic for coverage . Hypercholesterolemia is a major modifiable risk factor for CVD for both men and women.3 Low-density lipoprotein cholesterol (LDL-C) levels are typically lower in women than in men until menopause, when levels increase (from a mean of 117mg/dL [3mmol/L] to 145mg/dL [3.7mmol/L])6 and LDL particles tend to become more atherogenic.7 High-density lipoprotein cholesterol (HDL-C) levels are approximately 10mg/dL (0.3mmol/L) higher in women than in men,8 and low levels are more predictive of CHD in women compared with men, especially in women aged 65 years or older.3 Moreover, elevated triglycerides may be a more significant risk factor in women (especially older women) compared with men,4,9,10 and, for both sexes, elevated non-HDL-C is recognized as a risk marker for CHD,11 particularly in patients with hypertriglyceridemia, reflecting increased levels of atherogenic remnant very low-density lipoprotein (VLDL). (A) LS mean % change from baseline in LDL-C at week 6 (LOCF). Acknowledgments: Editorial support was provided by Pamela Mausner, MD, and funded by Pfizer Inc. Drs Hess and Hill are employees of Surveillance Data Inc. who are paid consultants in the development of the manuscript. The HERS Research Group. Statins, also known as HMG-CoA reductase inhibitors, are prescription medications that help improve cholesterol levels. Note that if a patient switched to more than 1 dose level of a generic simvastatin during the study period, the patient was counted in each of the dose levels of generic simvastatin prescribed. . The maximum daily dose should be adjusted so that the expected rosuvastatin exposure would not likely exceed that of a 40 mg daily dose taken without interacting medicinal products, for example a 20 mg dose of rosuvastatin with gemfibrozil or febuxostat (1.9-fold increase), and a 10 mg dose of rosuvastatin with combination ritonavir/atazanavir . Baseline Characteristics of 1,146 Women in the STELLAR Trial (Randomized Population). E-mail: Larry.Liu@pfizer.com. Pairwise comparisons for changes in lipids and achievement of lipid levels for rosuvastatin versus atorvastatin, simvastatin, and pravastatin. drug and then generic or vice versa, the patient was counted uniquely only once in this calculation. 2023 Healthline Media LLC. 1999;83:1476-1477. Your doctor will look at many factors when they decide which statin is safest for you, including your health and other medications you take. However, both are approved for use. 3Louisiana State University School of Medicine, New Orleans, Louisiana. AdultsAt first, 10 to 20 milligrams (mg) once a day. Cholesterol is a substance made in the liver thats vital to human life. Table 1, Statin Dosing and ACC/AHA Classification of Intensity - Statin Use for the Primary Prevention of Cardiovascular Disease in . Learn what you need to know about, If you are watching your cholesterol levels, you know that it is important to look at the cholesterol content, as well as saturated and trans fats, in. The Statin Therapies for Elevated Lipid Levels compared Across doses to Rosuvastatin (STELLAR) trial (clinicaltrials.gov identifier: {"type":"clinical-trial","attrs":{"text":"NCT00654537","term_id":"NCT00654537"}}NCT00654537) compared rosuvastatin treatment with three other widely used statins (atorvastatin, simvastatin, and pravastatin) in a hypercholesterolemic patient population.19 This subgroup analysis examines the effects of statin therapy in improving lipid profiles in the hypercholesterolemic women who participated in the STELLAR trial. "Vitamn C njdete v ovoc, ako s pomarane a jahody, a vitamn E v . Erratum in: Circulation. 16. Niacin both niacin and statins have been shown to cause muscle toxicity. Do not suddenly stop taking your prescribed medication without talking with your doctor first. 9. He says that whatever you eat, your baby will get those same nutrients, or lack thereof.. Most people will have a total cholesterol level of around 170 before pregnancy. The major difference is that Cialis lasts longer and can be taken daily, giving you erections on demand. 1998;82:128. 1998;81:582-587. Heres how you can reduce both. Ashwagandha is a medicinal herb with powerful health benefits for fertility, athletic performance, sleep, and more. Ob/Gyn & Women's Health. Trials in patients with hypercholesterolaemia have shown that rosuvastatin is more effective than atorvastatin at reducing LDL-C and achieving US and/or European LDL-C goals over treatment periods ranging from 6 to 52 weeks [25-30]. Blood for fasting lipid profiles, ROCK activity, and safety assessment was collected before and one month after statin treatment. Highs and lows in sexual desire may coincide with the beginning or end of a relationship, or major life changes, such as pregnancy or menopause. This action reduces your total cholesterol level, including your low-density lipoprotein (LDL), or bad cholesterol level. High cholesterol can be hereditary, but it can also be caused by other factors. Talk with your doctor about any side effects you have. Rosuvastatin 20mg reduced non-HDL-C significantly more than milligram-equivalent doses of atorvastatin, simvastatin, and pravastatin (p<0.002 for all comparisons). Erectile dysfunction (ED), formerly known as impotence, is a condition that affects roughly 40% of people with penises over the age of 40 and 70% over the age of 70. While this may appear alarming, it shouldnt be. These . Polygenic risk scores involves analyzing a persons genes to see if there are any variants, as variations can indicate their likelihood of developing. If you take multiple medications, your doctor might recommend a statin that is less likely to interact with other drugs, such as pravastatin and rosuvastatin. Whitehouse Station, NJ: Merck & Co, Inc; August 2005. 1998;28:327-333. For example, patients switching from atorvastatin 20 mg should receive more than 20 mg of simvastatin to receive a therapeutic dose equal to or higher than their atorvastatin dose, given the higher efficacy of atorvastatin at milligram-equivalent doses. Currently, there is no deadline by which all manufacturers must update their package inserts. In fact, some studies suggest that seven of every 10 people with ED meet the clinical definition of . Apo, apolipoprotein; PVD, peripheral vascular disease; SD, standard deviation; STELLAR, Statin Therapies for Elevated Lipid Levels compared Across doses to Rosuvastatin. Although the 2011 AHA and 2013 ACC/AHA lipid guidelines represent important directives in preventive cardiovascular care for women4,12 and awareness of CVD among women has increased over the last couple of decades, significant gaps in the understanding and management of the disease remain, particularly among black and Hispanic women.4,9,18,19,21 Indeed, the majority of women (approximately 85%) in the STELLAR trial were white, and so results from this and other statin studies need to be interpreted with caution in women of ethnic minorities. Objective: Cardiovascular disease is the leading cause of mortality in women in the United States. Zocor (simvastatin) [prescribing information]. Learn, Polygenic risk scores involves analyzing a persons genes to see if there are any variants, as variations can indicate their likelihood of developing. Expecting mothers experience a natural rise in their cholesterol levels. According to American Heart Association (AHA), a total cholesterol level below 200 is ideal, and anything above 240 is considered high. The study defined low-intensity statin therapy as treatment with fluvastatin, 20 to 40 mg, lovastatin, 20 mg, simvastatin, 10 mg, pitavastatin, 1 mg, and pravastatin, 10 to 20 mg. Statins do not influence homocysteine levels, while the effect of nicotinic acid and n3-fatty acids is less clear. Castelli WP, Garrison RJ, Wilson PW, et al.. 4. These are a few of the main differences between Lipitor and Crestor: Side effects: Lipitor and Crestor may both cause muscle pain and certain digestive . (2022). The higher the atorvastatin dose during the index month, the greater the percent age of switches to a lower therapeutic dose of simvastatin: 18%, 43%, 73%, and 100% for atorvastatin 10 mg, 20 mg, 40 mg, and 80 mg, respectively. The increases in HDL-C were numerically greater with rosuvastatin than with the other statins, but the differences were not statistically significant, except that rosuvastatin 20 and 40mg increased HDL-C significantly more than milligram-equivalent or higher doses of atorvastatin (Fig. Drug solubility may be a consideration when deciding on statin therapy. If youre pregnant or planning to become pregnant, talk with your doctor about whether or not you should continue taking statins. Mean ages, 5860 years, were similar across the statin groups. When youre pregnant, cholesterol rises naturally, labtestsonline.org.uk/tests/cholesterol-test, fda.gov/consumers/consumer-updates/controlling-cholesterol-statins, fda.gov/safety/medical-product-safety-information/statins-drug-safety-communication-fda-requests-removal-strongest-warning-against-using-cholesterol, ahajournals.org/doi/10.1161/CIR.0000000000001052, heart.org/en/health-topics/cholesterol/about-cholesterol/what-your-cholesterol-levels-mean, jogc.com/article/S1701-2163(15)30565-X/fulltext. Statin intolerance can be serious. 2006;113:e85-e151. This paper reviews key clinical results for a new agent, rosuvastatin. These effects can reduce your risk of heart attack or stroke. The Framingham Study, Comparison of the relation of triglyceride-rich lipoproteins and muscular artery compliance in healthy women versus healthy men, Hypertriglyceridemia as a cardiovascular risk factor, Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. 2004;110:763. Label:Lipitor- atorvastatin calcium tablet, film coated. Am J Cardiol. Graham Head, 66, who kidnapped and tried to rape two women, was caught after one victim remembered three digits of his car registration. Learn what you need to know about, If you are watching your cholesterol levels, you know that it is important to look at the cholesterol content, as well as saturated and trans fats, in. Atorvastatin 40mg to 80mg daily Re-check lipids at 3 months Target achieved? Both treatments were well tolerated. Am Heart J. American College of Cardiology/American Heart Association Statin Intensity Guidelines. Nevertheless, the data suggest that a substantial proportion of patients switching from atorvastatin to simvastatin may be receiving suboptimal therapy. Jones PH, Hunninghake DB, Ferdinand KC, et al.. Our website services, content, and products are for informational purposes only. Let's look deeper. When taken together, the risk may be greater. The following statins are currently available in the United States: Statins can also be found in combination medications, including Caduet (amlodipine/atorvastatin) and Vytorin (simvastatin/ezetimibe). These drugs all come in either a tablet or capsule that you take by mouth. 1. Use 40 mg dose only for patients not reaching LDL cholesterol goal with 20 mg. A 52-week, multicenter, randomized, parallel-group, double-blind, double-dummy study to assess the efficacy of atorvastatin and simvastatin in reaching low-density lipoprotein cholesterol and triglyceride targets: the Treat-to-Target (3T) study. Label:Pravastatin sodium tablet. [ 8] This LDL-C-lowering effect has been verified in several . Please review the latest applicable package insert for additional information and possible updates. Both before and after pregnancy, take care of ones own health, with a heart-healthy diet and exercise habits.. Gentile S,Turco S, Guarino G, et al. They are marketed as single-ingredient products, including Lipitor (atorvastatin), Lescol (fluvastatin), Mevacor (lovastatin), Altoprev (lovastatin extended-release), Livalo (pitavastatin), Pravachol (pravastatin), Crestor (rosuvastatin), and Zocor (simvastatin). Statins may not be suitable for everyone. A detailed description of the methods of the trial is provided elsewhere.19 Briefly, after a 6-week dietary lead-in period, men and women aged 18 years or older with fasting LDL-C 160mg/dL and <250mg/dL (4.1mmol/L and <6.5mmol/L) and triglycerides <400mg/dL (<4.5mmol/L), discontinued from all cholesterol-lowering drugs and dietary supplements, were randomized to 6 weeks of treatment with one of four statins. More recently the AHA, in collaboration with the American College of Cardiology (ACC), published guidelines on the treatment of cholesterol to reduce atherosclerotic cardiovascular risk in adults (men and women).12 These guidelines identify patients and provide treatment recommendations according to four statin-benefit groups (Tables 2, ,33). Further research is needed to assess the potential negative effect on patient outcomes. Statins block an enzyme in your body that creates cholesterol. Curr Med Res Opin. 17. Clin Cardiol. Women's health is once again the center of a political ping-pong match with evidence-based science on one side and anti-choice advocates on the other. National Library of Medicine Comparison of the efficacy and tolerability of simvastatin and atorvastatin in the treatment of hypercholesterolemia. (2022). Label:Simvastatin- simvastatin tablet. (2021). Dose-response effects of atorvastatin and simvastatin on high-density lipoprotein cholesterol in hypercholesterolaemic patients: a review of five comparative studies. Compared with the atorvastatin dose in the index month, 41% of switches to branded simvastatin resulted in a lower therapeutic dose. The 10 mg dose is considered low intensity, while the 20 mg and 40 mg doses are considered moderate intensity. However, of the 5023 switches from atorvastatin 20 mg to either branded or generic simvastatin, 2168 (43%) were to a lower therapeutic dose (15 switches to 5 mg, 220 to 10 mg, and 1933 to 20 mg . (2020). People who may not be able to take statins include: If you need to take a statin to help lower your cholesterol levels, you have several options. Stone NJ, Robinson JG, Lichtenstein AH, et al.. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. The percent of switches resulting in a lower therapeutic dose were 18% for those switching from 10 mg, 43% for those switching from 20 mg, 73% for those switching from 40 mg, and 100% for those switching from 80 mg. Statins, also known as HMG-CoA reductase inhibitors, are prescription medications that help improve cholesterol levels. Accessibility The FDA has requested that manufacturers update their package inserts to reflect the change. In relation to renal function, atorvastatin was the safest statin as it resulted in the least number of patients at the end of 2 years of treatment with the new onset of microalbuminuria (10.9%) followed by rosuvastatin (14.3%) and then pravastatin (26.6%). Rosuvastatin tablets: Dose range: 5-40 mg once daily. For some women, orgasm can be difficult to achieve causing concerns or preoccupations that lead to a loss of interest in . Stress and cholesterol are probably linked. Patients switching to simvastatin were also categorized by their dose level for atorvastatin in the index month and the dose level of the simvastatin they switched to, using the following criteria: 5. However, due to the theoretical risk and limited benefits of these medications in pregnancy, most authorities recommend stopping this class of medication during pregnancy.. 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