From the Guidelines
Pitavastatin is the statin with the least side effects, as it has been shown to have a lower propensity to cause muscle-related symptoms and does not increase the risk of new-onset diabetes (NOD) compared to other statins. According to the 2024 recommendations on the optimal use of lipid-lowering therapy, pitavastatin has a unique profile that makes it an ideal choice for patients with metabolic disturbances, diabetes, or pre-diabetes 1. The study found that pitavastatin reduced LDL-C effectively, with a mean reduction of 43-47%, and had a significant potential to reduce subsequent and total CVD events 1. Additionally, the REPRIVE trial showed that pitavastatin had a low incidence of muscle-related symptoms and did not increase the risk of diabetes mellitus compared to placebo 1.
Some of the key benefits of pitavastatin include:
- Lower risk of muscle-related symptoms compared to other statins
- No increase in the risk of new-onset diabetes (NOD)
- Effective reduction of LDL-C, with a mean reduction of 43-47%
- Significant potential to reduce subsequent and total CVD events
- Can be used in patients with statin intolerance, HIV, and elevated Lp(a) levels
The typical dose of pitavastatin is 4 mg once daily, and it can be used in combination with ezetimibe in patients with metabolic disturbances to increase the chance of reaching LDL-C targets and improving adherence 1. Overall, pitavastatin is a rational treatment choice for patients with metabolic disturbances, diabetes, or pre-diabetes, and its unique profile makes it an ideal option for patients who require a statin with the least side effects.
From the Research
Statin Options with Least Side Effects
- Pitavastatin is considered to have a low propensity for drug-drug interactions and a low incidence of myopathy or rhabdomyolysis 2
- A case report comparing pitavastatin with other statins found that pitavastatin demonstrated less potential for the development of myalgia compared to fluvastatin and pravastatin 3
- Pitavastatin is generally well tolerated in hyperlipidemic patients with or without type 2 diabetes, with the most common treatment-related adverse events being musculoskeletal or gastrointestinal in nature 2
Comparison of Statin Side Effects
- Statins can cause myotoxicity, in the form of myopathy, myalgia, myositis or rhabdomyolysis, with the exact pathophysiology not fully known 4
- The prevention of statin-related myopathy involves using the lowest statin dose required to achieve therapeutic goals and avoiding polytherapy with drugs known to increase systemic exposure and myopathy risk 4
- Pitavastatin has been shown to produce reductions from baseline in serum total and LDL cholesterol levels to a similar extent to those seen with atorvastatin and to a greater extent than those seen with simvastatin or pravastatin 2
Considerations for Statin Selection
- The choice of statin should be based on individual patient factors, including tolerance and therapeutic response 5
- Having a variety of statin agents to choose from is beneficial for patient care, considering the numbers of patients who need LDL-C-lowering therapy 5
- Pitavastatin may be a promising treatment choice for individuals who are intolerant to statin therapy due to muscle complaints 3