Which statin is best?: I am 45 years... - British Heart Fou...

British Heart Foundation

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Which statin is best?

Wombat26 profile image

I am 45 years old and was diagnosed with familial hyperlipideamia over 20 years ago. I was seen at the lipid clinic at Guys hospital and been taking Rosuvastatin 20mg and Exetrol 10mg for many years with no side effects and good results. I am currently working in South Africa and have private medical cover. They don’t want to pay for the Rosuvastatin and want me to change to Atorvastatin 40mg a day. Is there any research or medical recommendations that support this? Which statin is best?

10 Replies
MichaelJH profile image
MichaelJHHeart Star

There is no "best" statin. I have issues with Simvastatin but not Atorvastatin. Others here are the opposite. Sometimes Rouvastatin is used if there are issues with the ones previously mentioned. Try it and see how it goes. If there is an issue (unlikely) they cannot really refuse to treat you with appropriate medication!

Hi. Like you I have Familial Hypercholestraemia. However I have had issues with all the statins. The one with the least problems for me (I can’t feel my feet!) is pravastatin. The lipid clinic tried to change me to Rosuvastatin just 3 times per week but I had a worse reaction to that than the pravastatin! So as Michael says it will be a case of try them and see. Not sure how they can refuse if it’s medically prescribed unless they have a further medical assessment of you. Good luck hope it gets sorted for you. Best wishes. Zena

I am not a medic but statins all do the same job but not all statins are tolerated be everyone - its very much a suck it and see type of approach. Atorvastatin will certainly reduce your cholesterol levels - its the one I take. My wife takes Symvastatin and it works for her. Others will tell you they had side effects with one or both of these. There is no definitive answer here.

I would push your insurance company to keep you on your prescribed meds but otherwise I'd try atorvastatin, see how it goes, if its OK, good, if not try one of the others.

My husband and I both take Atorvastatin . Neither of us have any side effects.

A Mediterranean diet, relatively low in carbohydrate and including nuts or olive oil at most meals has been proven way more effective for reducing heart disease than any medication.

NathanBlau profile image
NathanBlau in reply to Concerned

I think you have a point that the Mediterranean diet can reduce the risk of another heart attack but I would like to see some evidence that it has been 'proven way more effective than any medication". Maybe you could provide a link?

Concerned profile image
Concerned in reply to NathanBlau

A direct comparison is not available. However, if we take the statistics from statin studies and compare them to the prevention rates of PREDIMED, the diet is far more effective. Pharmaceutical companies already use relative statistics to paint their product in the best light possible by comparing numerators and glossing over denominators, but where hard data has been published, the actual rates of prevention of a CHD/stroke incident are far from impressive.


450 events per 10,000 is 4.5%. Or, put another way, may not prevent 95.5% of events. Hardly impressive. These stats ought to be quoted to patients (and health professionals) to make an informed decision.

NathanBlau profile image
NathanBlau in reply to Concerned

I respect your position on this but I am not sure how many are ready to ditch their medication for a diet. I read the reference you provide but I frankly don’t really comprehend the wording as it seems quite contrary to most clinical studies.

Indeed a US medical journal quotes .....

“As with all medications, the amount that an individual will benefit from using a statin will vary. But on the whole, statins have been shown to help reduce the risk of heart attacks and the complications of heart disease pretty significantly. In fact, in a recent review of 19 clinical trials that examined how helpful statins were in preventing cardiovascular events in people who had never had an event before, statins were associated with a 31 percent reduction in the risk of dying from a cardiac event and a 36 percent reduction in risk of having a heart attack.”

Confusing isn’t it?

Concerned profile image
Concerned in reply to NathanBlau

Yes. They're using relative risk again. We need to know the absolute risk.

Neither would I dare encourage anyone to not take medication. That's an informed decision that needs to take place between the patient and doctor.

MichaelJH profile image
MichaelJHHeart Star in reply to NathanBlau

The impressive statistic about statins is whilst they have been in use the average age of surgical intervention has gone up by ten years! A lifetime on a Mediterranean diet reduces the incidence of heart disease as does switching to it. I have seen no reliable evidence that it reverses CVD once established.

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