Would choosing 2mg of statin have fewer side effects?

Statins are basic medications for lowering cholesterol and low-density lipoprotein cholesterol. Statins are also basic medications for anti-vascular inflammatory responses, stabilizing plaques in blood vessels, preventing plaque rupture and thrombus formation, thereby preventing myocardial infarction and cerebral infarction.
Therefore, statins are the most basic drugs for patients with hypercholesterolemia and ischemic cardiovascular and cerebrovascular diseases.

However, what people are most worried about for a long time is the side effects of statins.

Some people may ask, since the side effects of statins cannot be completely avoided, can we choose a statin with a smaller dose? For example, fluvastatin is 40mg, atorvastatin is 20mg, but pitavastatin is only 2mg. Why should we choose 40mg or 20mg of statin? Can't we just choose 2mg of statin?
After a quick look, we found that 40mg is 20 times greater than 2mg, and 20mg is indeed 10 times greater than 2mg. So does anyone understand that 2mg of statin has 10 times less side effects than 20mg of statin?

1. Common Statins

There are seven common statins on the market:

First generation: including lovastatin, simvastatin, and pravastatin;
Second generation: includes fluvastatin;
The third generation: includes atorvastatin, rosuvastatin, and pitavastatin.
The first and second generation statins are short-acting statins, which means they have a short half-life. After taking them, they only work for a short time in the body. Therefore, the first and second generation statins need to be taken at night to play a role in lowering blood lipids. If you take the first and second generation statins during the day, the drug effect will disappear at night and they will not play a lipid-lowering role.
The third-generation statins are long-acting statins with a longer half-life. The third-generation statins have the same effect when taken during the day or at night.

2. The recommended dose of each statin is different

The recommended doses of common statins are as follows:

Lovastatin (20 mg), simvastatin (20 mg), pravastatin (10 mg), fluvastatin (40 mg), atorvastatin (20 mg), rosuvastatin (10 mg), pitavastatin (2 mg).
If we look at the dosage alone, 40 mg of fluvastatin is indeed 20 times greater than 2 mg of pitavastatin.
But we must understand here that this is the recommended dose of the drug. In other words, to put it simply, the effective dose of 40 mg of fluvastatin is equivalent to the effective dose of 20 mg of atorvastatin, which is equivalent to the effective dose of 10 mg of rosuvastatin, and which is equivalent to the effective dose of 2 mg of pitavastatin.

We know a drug. We cannot use 40 mg of fluvastatin to directly compare with 2 mg of pitavastatin. We think that since the dosage of fluvastatin is 20 times that of pitavastatin, the effect is 20 times greater, and the side effects are also 20 times greater.
A drug can only be compared with its own dose. For example, 40 mg of atorvastatin is twice as high as 20 mg of atorvastatin, so the side effects and side effects will increase significantly. You cannot compare fluvastatin with 20 mg of atorvastatin or 2 mg of pitavastatin.
The recommended dose mentioned here generally refers to the regular dose of statins for adults, that is, the dose when everyone chooses this statin, for example: if you choose pitavastatin, it is 2 mg, if you choose rosuvastatin, it is 10 mg, and if you choose atorvastatin, it is 20 mg.

3. Positive effects and side effects of statins:

Positive effects:

Generally, we compare statins by their ability to lower low-density lipoprotein cholesterol, which is generally divided into three levels: low-intensity, medium-intensity, and high-intensity lipid-lowering:
1. Low-intensity lipid-lowering can generally reduce low-density lipoprotein cholesterol by about 30%:
Fluvastatin 20-40 mg or simvastatin 10 mg or pravastatin 10-20 mg or pitavastatin 1 mg
2. Moderate-intensity lipid-lowering therapy can generally reduce low-density lipoprotein cholesterol by 30% to 50%:
Atorvastatin 10-20 mg or rosuvastatin 5-10 mg or simvastatin 20-40 mg or pravastatin 40 mg or pitavastatin 2-4 mg
3. High-intensity lipid-lowering, generally can reduce high-density lipoprotein cholesterol by more than 50%:
Atorvastatin 40-80 mg or rosuvastatin 20-40 mg

side effect:

Based on the recommended dose, such as 40 mg of fluvastatin, 20 mg of atorvastatin, 10 mg of rosuvastatin, and 2 mg of pitavastatin, there is not much difference in the side effects of various statins.
Theoretically, side effects may occur. According to medical history, choosing 2mg of statin has a lower risk of side effects than 40mg of statin.
But for the same drug, such as rosuvastatin 5mg and rosuvastatin 20mg, the greater the dose, the greater the risk of side effects.
Therefore, for the same drug, the greater the dosage, the greater the side effects; if they are not the same drugs, they cannot be compared.

4. There is no absolutely safe statin, but there is no statin as dangerous as you think.

So many people must want to know which statin is the safest and has no side effects.

Theoretically, let alone statins, almost all drugs have side effects, so there is no statin that is 100% safe.
But don't be alarmed by some people's words. Statins are not drugs that damage the liver, kidneys, or muscles. These side effects of statins only occur in a few people. If you do a good job of monitoring, discover problems in time, and solve them in time, there will be no serious consequences.
For those who should take statins, they should take them and should not refuse to take the medicine because of the so-called amplified side effects. Refusing statins may lead to more cardiovascular and cerebrovascular diseases, or even myocardial infarction and cerebral infarction.
As for which specific statin to choose, it depends on the situation. The general principle is that low-density lipoprotein cholesterol determines which statin we choose.

That is to say, no matter which statin I choose, my LDL cholesterol should meet the standard after taking it, which means that this statin is suitable for me. Finally, I would like to add that there are three standards for LDL cholesterol, and different standards are used for different groups of people. If you are below 1.8mmol/L, below 2.6mmol/L, or below 3.4mmol/L, please refer to Dr. Wang’s other popular science articles. I will not elaborate on them here!