From the Guidelines
Pitavastatin is the statin with the least amount of side effects, as it has been shown to have a favorable safety profile, with a low incidence of muscle-related symptoms and no apparent treatment effect on glucose levels, making it a rational treatment choice in patients with metabolic disturbances, diabetes, or pre-diabetes 1. When considering the safety profile of statins, it's essential to look at the most recent and highest quality studies. The 2024 recommendations on the optimal use of lipid-lowering therapy in established atherosclerotic cardiovascular disease and following acute coronary syndromes, published in the journal Drugs, highlight the benefits of pitavastatin 1. Some key points to consider include:
- Pitavastatin has a potent inhibitory effect on HMG-coenzyme A reductase, reducing LDL-C effectively by a mean of 43-47% 1.
- It has pleiotropic effects, which may be beneficial in specific patient groups, such as those with metabolic disturbances or diabetes 1.
- Pitavastatin does not increase the risk of new-onset diabetes (NOD) and may even have a slight optimizing effect on fasting blood glucose and HbA1c levels 1.
- The REPRIVE trial, which included 7769 participants with HIV infection, showed that pitavastatin had a low incidence of muscle-related symptoms and no apparent treatment effect on glucose levels 1.
- A recent substudy also revealed that pitavastatin decreased the mean noncalcified plaque volume and reduced the progression of noncalcified plaque compared to placebo 1. Overall, the evidence suggests that pitavastatin is a safe and effective treatment option for patients with hyperlipidemia, particularly those with metabolic disturbances or diabetes, due to its favorable safety profile and pleiotropic effects 1.
From the Research
Statin with the Least Amount of Side Effects
- Pitavastatin is considered to have a favorable pharmacokinetic profile and is generally well tolerated in hyperlipidemic patients with or without type 2 diabetes 2.
- The most common treatment-related adverse events associated with pitavastatin are musculoskeletal or gastrointestinal in nature, with increases in plasma creatine kinase levels seen in <5% of pitavastatin recipients 2.
- Pitavastatin has a low propensity for drug-drug interactions due to its minimal metabolism by cytochrome P450 (CYP) enzymes 2, 3.
- Compared to other statins, pitavastatin has been shown to have a similar LDL-C-lowering effect, but also has a strong HDL-C-elevating effect and does not worsen glucose metabolism 4.
- A study comparing pitavastatin to atorvastatin found that pitavastatin was associated with trends towards increased HDL cholesterol levels, and had a similar efficacy in reducing LDL cholesterol levels 2.
Comparison to Other Statins
- Pitavastatin is about 6-fold more potent than atorvastatin, 1.7-fold more potent than rosuvastatin, 77-fold more potent than fluvastatin, and 3.3-fold less potent than cerivastatin in reducing LDL cholesterol 5.
- Pitavastatin has been shown to have a similar efficacy to other strong statins, such as atorvastatin and rosuvastatin, in reducing LDL cholesterol levels 4.
- A review of clinical trials found that pitavastatin had a strong HDL-C-elevating effect and did not worsen glucose metabolism, making it a suitable option for long-term use 4.
Muscle Pain and Side Effects
- Statin-associated muscle pain is a common adverse event, but the evidence in support of muscle pain caused by statins is often equivocal and not particularly strong 6.
- A review of randomized controlled trials found that statins, including pitavastatin, are generally well tolerated and have a similar rate of muscle-pain related side-effects to placebo 6.
- Exchange of statin or reduction of dose may be beneficial in managing potential side effects, especially in primary prevention 6.