There are many statins, with commonly used ones in clinical practice including atorvastatin and rosuvastatin.
Lipid-lowering Effect and Rhabdomyolysis Complications
Effectiveness: Rosuvastatin > Atorvastatin
The stronger the effect and the higher the dose, the greater the possibility of rhabdomyolysis (the specific mechanism has not been found yet).
Lovastatin, simvastatin, and atorvastatin are metabolized by CYP3A4. CYP3A4 inhibitors (such as cyclosporine, erythromycin, clarithromycin, ketoconazole, diazepam, verapamil, amiodarone, and diltiazem) used simultaneously with statins inhibit CYP3A4 metabolism, increasing statin blood concentrations and causing a higher incidence of adverse reactions.
If the combination with CYP3A4 inhibitors is necessary, priority should be given to choosing fluvastatin, pravastatin, rosuvastatin, and pitavastatin.
Metabolism
The primary site of statin metabolism is the liver. Liver damage primarily results in elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. The incidence of ALT or AST exceeding three times the normal value is 0.5% to 2.0%.
The severity of liver damage is related to the type and dose of statins. Patients treated with lovastatin, atorvastatin, fluvastatin, and rosuvastatin show no significant changes in transaminases, whereas patients using simvastatin can experience rapid increases in transaminase levels in the short term. After discontinuation or switching to other lipid-lowering drugs along with hepatoprotective treatment, liver function often recovers spontaneously.
[[Atorvastatin]] is water-soluble, mainly metabolized by the liver, with little impact on renal function, and can be used in renal insufficiency.
[[Rosuvastatin]] is lipophilic, requiring both liver and kidney metabolism, and is contraindicated in renal insufficiency.