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High cholesterol is a major risk factor for heart disease and stroke. Since heart disease is the number one killer of Americans, and stroke is the third leading cause of death in the country, reducing high LDL (bad) cholesterol can be a life or death battle. Diet and exercise are the first line of defense. If lifestyle changes alone aren't sufficient to reduce cholesterol to a safe level, drug treatment is usually considered. Statins are the most effective medications currently available for reducing LDL (bad) cholesterol.

11 million Americans currently take statins, which work by inhibiting HMG-CoA reductase (an enzyme utilized in the synthesis of cholesterol)in the liver. When HMG-CoA reductase is inhibited, LDL receptors are stimulated causing them to clear more LDL from the bloodstream, in turn lowering LDL cholesterol by 30 to 50 percent.

There are a number of statins currently in use, which have varying degrees of potency. They are listed below in order from the most potent to the least. Pitavastatin (Livalo, Pitava), although currently in use, is not included because it is as yet unclear where it falls in the ranking.

Rosuvastatin (Crestor)

Atorvastatin (Lipitor, Torvast)

Simvastatin (Zocor, Lipex)

Lovastatin (Mevacor, Altocor)

Pravastatin (Pravachol, Selektine, Lipostat)

Fluvastatin (Lescol)

While the benefits of statin therapy are well studied, the medications are not without risks. Although they are generally well tolerated, muscle pain and cramps are frequently reported amongst patients taking statins. Other side affects have also been reported, although the jury is still out on whether they are caused by the medication. They include problems with memory and concentration, fluctuations in mood, irritability, headaches, and abdominal pain. Tingling or burning in the hands and feet has also been reported. These side affects are generally mild and may resolve over time. Although rare, changes in liver function can occur so your doctor should do periodic liver function tests.

More serious adverse reactions are very rare but include myositis (inflammation of the muscles) or myopathy (a disease in which muscle fibers do not function). In a small number of patients, myopathy has progressed to a dangerous condition called rhabdomyolysis, involving the rapid breakdown of muscle tissue which releases enzymes and cell byproducts into the bloodstream which can injure the kidney. In a number of patients this led to acute renal failure that in some cases was fatal. In 2001

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