Statins such as Lipitor or Crestor are used to treat cardiovascular disease and diabetes, what’s the difference? and is one better than the other?
Cardiovascular disease is a collective term that describes diseases relating to the circulatory system. The most prevalent cardiovascular diseases include heart failure, heart attacks, strokes, peripheral vascular disease, and ischemic heart disease. Risk is increased by a family history of the disease, old age, and an increase in low-density lipoprotein (LDL). Most forms of cardiovascular disease are treatable with statin medications.
How do statins prevent cardiovascular disease?
Statins are a group of medications used for the treatment of cardiovascular disease and diabetes. Statin medications such as atorvastatin (commonly known as Lipitor) and rosuvastatin (commonly known as Crestor) block the formation of cholesterol and contribute to the reduction of triglycerides.
Patients exhibit high LDL cholesterol levels that contribute to inflammation and plaque buildup. There are two pathways in which statins decrease blood cholesterol. The primary pathway involves inhibiting the production of the enzyme, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase. HMG-CoA reductase is involved in the metabolic production of cholesterol. This explains why statins are referred to as, HMG-CoA reductase inhibitors.
Another pathway involves increasing LDL receptors in the liver, which lowers blood cholesterol levels by increasing cholesterol absorption by liver cells. LDLs transport cholesterol from the liver to the tissues allowing cholesterol to accumulate, causing cardiovascular disease. High density lipoproteins (HDLs) transport cholesterol in the opposite direction. A person in good health will have total cholesterol LDL levels below 130 mg/dL and HDL levels above 45mg/dL.
Crestor has a bioavailability of 14% while Lipitor has a bioavailability of 20%. The distribution of Lipitor through protein binding is over 98% while for Crestor it is 88%. Lipitor has a half-life of 14 hours while Crestor has a half-life of 19 hours. There are more similarities than differences between Lipitor and Crestor.
Further research investigating the disadvantages and advantages of either medications is needed for consumer advice.
Dosage, Side Effects & Drug Interactions
For detailed information on dosages, side effects, and drug interaction specific to you, always consult your healthcare provider before making changes to any medication (or supplement) regimen.
A physician will typically prescribe 10 to 20 mg of Lipitor for moderate strength which reduces cholesterol by 30% to 50% or 40 to 80 mg for higher strength cholesterol levels which reduces cholesterol over 50%. Similarly, Crestor is prescribed at 5 mg, 10 mg, 20 mg, and 40 mg.
Side effects of Lipitor may include nausea, insomnia, muscle aches, and muscle weakness. Individuals with kidney complications who take Lipitor may experience increased muscle complications. Those who are pregnant, breastfeeding, or have a present liver disease should avoid Crestor. Adverse effects of Crestor may include muscle aches and muscle weakness, or in extreme conditions renal failure.
Statin medications increase the liver’s metabolic processes. As such, individuals with chronic hepatic disorders are at a greater risk of developing liver damage. Hepatotoxicity of statins is more significant in people with symptomatic or persistent liver damage than those without hepatic dysfunction. Fortunately, the success of statin medications does not contribute to the overall risks of liver damage. In addition to lowering cholesterol and triglyceride concentrations, statins inhibit the development of liver degradation. Overall, there are minimal side effects of using Lipitor or Crestor for those with liver complications.
Certain drugs may interact with statins. CYP3A4 inhibitors interacting with Lipitor may increase plasma concentrations contributing to muscle disease. Some drugs such as bezafibrate, ciprofibrate, and colchicine interacting with Crestor may contribute to muscle pain and other symptoms of muscle disease.
Grapefruit juice may also interact with certain statin drugs. Furanocoumarins—compounds found in grapefruit juice— are the primary substances affecting statins. Grapefruit juice decreases intestinal CYP3A4—a molecule contributing to the breakdown of statins, thereby increasing the concentration of statins in the bloodstream. A recent study presented that Lipitor in the blood increased by 80% after the consumption of grapefruit juice. Lipitor is metabolized by CYP3A4, while Crestor is metabolized by CYP2C9.
It is important to speak to your doctor about the effects of statin medication in relation to food and drug interactions.
Cardiovascular Risk Factors
The primary and most discussed risk factors include high blood pressure or hypertension, lipid disorders, increased body mass, and diabetes. An increased concentration of procoagulants—proteins involved in the production of blood clots such as fibrinogen, can contribute to a higher risk of cardiovascular disease. Studies show that nutrition has a significant impact on the development of CVD. Individuals who consume a Mediterranean diet (higher consumption of fruits, vegetables, olive oil, whole grains, and nuts) are less at risk of inflammation and high blood pressure. Furthermore, individuals who adopt this diet are at a greater advantage of improving their lipids, glucose metabolism, and microbiome.
A promising study investigated the relationship between a Mediterranean diet and CVD. Results showed that individuals who did not adopt a Mediterranean diet had a higher frequency of inflammatory factors that those who did adopt this diet.
Overall, statins have demonstrated effectiveness in decreasing the risk of cardiovascular disease, cancer, and liver damage. Speak with your doctor about whether Lipitor or Crestor are right for you.
In the meantime, practicing a healthy lifestyle (both mentally and physically), getting regular exercise, eating a healthy and balanced diet, managing stress are some ways to improve your health and possibly prevent cardiovascular disease.
Bajaj T, Giwa AO. Rosuvastatin. [Updated 2020 Jun 2]. In: StatPearls [Internet]. Treasure Island
(FL): StatPearls Publishing; 2020 Jan-. Available from:
Berne, C., Siewert-Delle, A., & U. (2005, June 3). Comparison of rosuvastatin and atorvastatin
for lipid lowering in patients with type 2 diabetes mellitus: Results from the URANUS study. Cardiovascular Diabetology. Retrieved from
Canada, P. (2017, February 10). Government of Canada. Retrieved from https://www.canada.ca/en/public-health/services/publications/diseases-conditions/heart-disease-canada.html
Cardiovascular Disease. (n.d.). Retrieved January 06, 2021, from https://www.publichealthontario.ca/en/diseases-and-conditions/chronic-diseases-and-conditions/cardiovascular-disease
Casas, R., Castro-Barquero, S., Estruch, R., & Sacanella, E. (2018, December 11). Nutrition and Cardiovascular Health. International Journal of Molecular Sciences. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6320919/pdf/ijms-19-03988.pdf
Huff T, Boyd B, Jialal I. Physiology, Cholesterol. [Updated 2020 Aug 24]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:
InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health
Care (IQWiG); 2006-. High cholesterol: Overview. 2013 Aug 14 [Updated 2017 Sep 7].
Available from: https://www.ncbi.nlm.nih.gov/books/NBK279318/
McIver LA, Siddique MS. Atorvastatin. [Updated 2020 Sep 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430779/
Rosiek, A., & Leksowski, K. (2016, August 8). The risk factors and prevention of cardiovascular disease: The importance of electrocardiogram in the diagnosis and treatment of acute coronary syndrome. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982493/pdf/tcrm-12-1223.pdf
Schierwagen, R., Erhard Uschner, F., Magdaleno, F., Klein, S., & Trebicka, J. (2017, March 1). Rationale for the use of statins in liver disease. American Physiological Society Retrieved from https://journals.physiology.org/doi/pdf/10.1152/ajpgi.00441.2016
Thapar, MD, M., W. Russo, MD, M., & L. Bonkovsky, MD, H. (2013, September). Statins and Liver Injury. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983981/
W. Lee, BS, J., K. Morris, PhD, J., & J. Wald, FRS, N. (n.d.). Grapefruit Juice and Statins. Retrieved from https://www.amjmed.com/action/showPdf pii=S0002-9343%2815%2900774-3
Young, S., & Fong, L. (2012, March 22). Lowering plasma cholesterol by raising LDL receptors–revisited. Retrieved January 06, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5611813/
Image by Miguel Á. Padriñán from Pixabay