How to Choose a Statin? The Answer Lies

How to Choose a Statin? The Answer Lies in Individual Differences in Side Effects and Efficacy

 

When it comes to statins, many people ask, "Which one has the fewest side effects and the best efficacy?" In fact, there is no uniform answer to this question—statins exhibit significant individual differences in both side effects and efficacy. The selection must be comprehensively judged based on an individual's specific circumstances, and there is no "one-size-fits-all optimal solution" applicable to everyone.

 

From the perspective of side effects, different statins have distinct safety profiles. For example, pravastatin is not metabolized by the liver's CYP3A4 enzyme, which means it carries a relatively lower risk of drug interactions with other medications and has a smaller impact on the liver. It is suitable for people who need to take multiple drugs simultaneously or have sensitive liver function. On the other hand, while rosuvastatin and atorvastatin have outstanding lipid-lowering effects, some patients may experience side effects such as muscle pain and elevated liver enzymes. Additionally, rosuvastatin has certain requirements for renal function, and patients with impaired renal function need strict dosage adjustments. Overall, the incidence of overall side effects of moderate-to-low-intensity statins (such as pravastatin and simvastatin) is usually lower than that of high-intensity statins (such as atorvastatin and rosuvastatin). However, whether a specific individual can tolerate a drug still needs to be observed after they start taking it.

 

In terms of efficacy, the core function of statins is to lower low-density lipoprotein cholesterol (LDL-C, known as "bad cholesterol"), and different statins vary significantly in their lipid-lowering strength. Among them, rosuvastatin and atorvastatin are classified as high-intensity statins. At the same dosage, they reduce LDL-C to a greater extent, making them more suitable for patients who require a significant reduction in cholesterol—such as those with coronary heart disease or diabetes combined with hypercholesterolemia. In contrast, moderate-to-low-intensity statins like pravastatin, simvastatin, and pitavastatin have relatively mild lipid-lowering effects. They are more suitable for patients with mild cholesterol elevation or poor tolerance to high-intensity statins, such as the elderly and individuals with weak liver or kidney function.

 

It is particularly important to note that statins are prescription drugs and cannot be chosen arbitrarily based solely on "the number of side effects" or "the strength of efficacy." Doctors will comprehensively evaluate factors such as your lipid levels (especially the target value of LDL-C), underlying diseases (e.g., whether you have hypertension, diabetes, or coronary heart disease), concurrent use of other medications, age, and liver/kidney function to formulate an appropriate medication plan. During the medication period, it is also necessary to regularly recheck indicators such as liver enzymes and creatine kinase to promptly detect and address potential side effects, ensuring the safe and effective use of the drug.