From the Guidelines
Atorvastatin is the statin that tends to have a less positive effect on HDL levels compared to other statins like rosuvastatin and simvastatin. No statin medication is specifically designed to lower HDL (high-density lipoprotein) cholesterol, which is often referred to as "good cholesterol." In fact, statins generally have a neutral to slightly positive effect on HDL levels, typically increasing HDL by 5-10% 1. However, among the available statins, rosuvastatin and simvastatin tend to have the most favorable effects on raising HDL, while atorvastatin and pitavastatin may have comparatively less positive effects on HDL levels.
Key Points to Consider
- The primary mechanism of statins is to inhibit HMG-CoA reductase, which reduces LDL (low-density lipoprotein) production in the liver 1.
- If a patient experiences a decrease in HDL while taking a statin, this is likely due to other factors such as diet, exercise habits, smoking, or concurrent medications rather than a direct effect of the statin itself.
- Patients concerned about maintaining or improving their HDL levels while on statin therapy should discuss this with their healthcare provider, as lifestyle modifications including regular exercise, weight management, and limiting alcohol consumption can significantly impact HDL levels.
Statin Therapy Considerations
- The 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol provides guidance on the use of statin therapy for the prevention and treatment of cardiovascular disease 1.
- The guideline recommends the use of high-intensity statin therapy for patients with acute coronary syndrome, and moderate-intensity statin therapy for patients with other forms of atherosclerotic cardiovascular disease.
- The choice of statin and dose should be individualized based on the patient's specific needs and circumstances, including their LDL-C level, cardiovascular risk factors, and potential for drug interactions.
From the Research
Statin Effects on HDL Levels
- The effects of statins on high-density lipoprotein (HDL) cholesterol levels have been studied in various clinical trials 2, 3, 4, 5.
- Simvastatin has been shown to increase HDL-C levels by approximately 3% to 10% in hypercholesterolemic patients 2, 3.
- Atorvastatin, on the other hand, has a different dose-response effect on HDL-C levels, with lower doses increasing HDL-C and higher doses having a diminished effect 4.
- Rosuvastatin has been found to increase apo A-I levels, with the highest increase observed at a dose of 20 mg 5.
- A comparison of the effects of rosuvastatin, atorvastatin, simvastatin, and pravastatin on non-HDL-C, apo B, and lipid ratios found that rosuvastatin was more efficacious in improving the lipid profile of patients with hypercholesterolemia 5.
Comparison of Statin Effects on HDL
- The study by 4 compared the dose-response effects of atorvastatin and simvastatin on HDL-C levels and found that simvastatin increased HDL-C levels more than atorvastatin at higher doses.
- Another study by 5 compared the effects of rosuvastatin, atorvastatin, simvastatin, and pravastatin on non-HDL-C, apo B, and lipid ratios and found that rosuvastatin was more efficacious in improving the lipid profile of patients with hypercholesterolemia.
- The study by 3 found that statins, in general, raise HDL-C levels, with the percentage changes being greater in patients with low baseline levels.
Statin-Specific Effects on HDL
- Simvastatin: increases HDL-C levels by approximately 3% to 10% 2, 3.
- Atorvastatin: has a different dose-response effect on HDL-C levels, with lower doses increasing HDL-C and higher doses having a diminished effect 4.
- Rosuvastatin: increases apo A-I levels, with the highest increase observed at a dose of 20 mg 5.
- Pravastatin: has a smaller effect on HDL-C levels compared to other statins 5.
It appears that atorvastatin may cause lower HDL levels at higher doses compared to simvastatin and rosuvastatin 4, 5.