- Heart Disease (Coronary Artery Disease) Slideshow Pictures
- Atrial Fibrillation Slideshow: Causes, Tests and Treatment
- Take the Heart Disease Quiz!
- Atorvastatin vs. simvastatin comparison
- What are atorvastatin and simvastatin?
- What are the uses for atorvastatin and simvastatin?
- What are the side effects of atorvastatin and simvastatin?
- How should atorvastatin and simvastatin be taken (dosage)?
- Which drugs interact with atorvastatin and simvastatin?
- Are atorvastatin and simvastatin safe to take during pregnancy or while breastfeeding?
Atorvastatin vs. simvastatin comparison
Atorvastatin and simvastatin both target the same chemical in the body to reduce drastically the bloodstream levels of LDL (low-density lipoprotein, or "bad cholesterol"), which lowers the risk it will clog up arteries, a central cause of cardiovascular problems.
These drugs also modestly raise levels of "good cholesterol" (HDL or high-density lipoprotein).
Both Lipitor and Zocor are good for lowering LDL, but Zocor is better at increasing HDL and tends to have fewer gastrointestinal side effects, according to one study.
Both atorvastatin and simvastatin share some possible side effects, including:
- liver damage,
- muscle inflammation and damage, and
- increases in blood sugar levels as seen in diabetes.
Lipitor and Zocor differ on a number of other less serious side effects.
A large number of drugs interact with both atorvastatin and simvastatin, so be sure to tell your doctor about all your other medications if they prescribe you either of these cholesterol drugs.
What are atorvastatin and simvastatin?
Atorvastatin and simvastatin are both chemicals that interfere with liver cells' cholesterol production. They are in a family of statins which also includes:
The molecules of the medications target an enzyme called HMG-CoA reductase, one step in the chemical process cells use to fabricate cholesterol from simpler types of molecules. Because of this, statins are called "HMG-CoA reductase inhibitors."
Cholesterol is essential for many body functions, including hormone production, cell structure, lining of nerve cells, digestion, and more. The body can make all the cholesterol it needs, but foods also contain cholesterol the body can use.
A healthy liver can balance cholesterol levels, but too much cholesterol in the bloodstream in LDL form leads to a host of cardiovascular diseases. The excess LDL forms plaques on artery walls, narrowing blood vessels to cause clots and blockages that can lead to coronary heart disease, stroke, heart attack, and other debilitating or fatal problems.
Lipitor and Zocor, as well as other statins, stop the cholesterol-making process in the liver cells by grabbing onto and binding up HMG-CoA reductase before it becomes cholesterol, sabotaging the cell's cholesterol factory.
When the liver cells can't make enough of their own cholesterol anymore because of the statin treatment, the body's cholesterol balancing impulse kicks into action, causing liver cells to suck up more LDL from the bloodstream. The cells break down the LDL into cholesterol to make up for the shortfall in production. As a consequence, less LDL is floating around in the bloodstream to add to arterial plaque deposits, thus substantially reducing cardiovascular disease risk.
Statins like atorvastatin and simvastatin also modestly increase HDL (high-density lipoproteins) in the bloodstream, which is the so-called "good cholesterol." Good levels of HDL molecules are healthy because they act as scavenger molecules, grabbing LDL from the bloodstream and taking it to the liver for processing and removal.
Researchers don't yet understand exactly how statins increase HDL.
What are the uses for atorvastatin and simvastatin?
- heart attack,
- hospitalization for congestive heart failure, and
- revascularization procedures in individuals with coronary artery disease.
Lipitor and Zocor reduce the risk of heart attack, stroke, angina and revascularization procedures in adults with multiple risk factors for coronary artery disease. Atorvastatin and simvastatin also prevent heart attacks and strokes in patients with type 2 diabetes with multiple risk factors for coronary artery disease.
What are the side effects of atorvastatin and simvastatin?
Side effects common to both Lipitor and Zocor include:
The most serious possible side effect of both Lipitor and Zocor is liver damage. Statins will usually affect the results of liver tests soon after treatment starts, but then return to normal. Doctors should stop administering atorvastatin or simvastatin if liver tests for certain chemical markers remain three times normal concentrations for an extended period.
Muscle inflammation caused by Lipitor and Zocor can cause serious damage if muscle protein (myoglobin) leeches into the bloodstream. This can cause rhabdomyolysis, a potentially fatal condition that can cause kidney failure because those organs cannot filter myoglobin.
Anonther concern with both atorvastatin and simvastatin is they can raise blood sugar and HbA1c levels, mimicking conditions seen in diabetes.
How should atorvastatin and simvastatin be taken (dosage)?
- Lipitor is prescribed once daily. The usual starting dose for adults is 10-20 mg per day, and the maximum dose is 80 mg per day. Adults who need more than a 45% reduction in LDL cholesterol may be started at 40 mg daily.
- Pediatric patients should receive 10 mg once daily up to a maximum dose of 20 mg daily. Lipitor may be taken with or without food and at any time of day.
- The recommended dose range of simvastatin is 10 mg to 40 mg, and it is administered once daily in the evening with or without food. People usually start with 10 or 20 mg daily, but those with high heart disease risk can start with 40 mg daily.
- Simvastatin 80 mg is restricted to patients who have been taking simvastatin 40 mg long-term (for example, for a year or more) without evidence of muscle toxicity. The 80 mg dose is associated with increased risk of muscle toxicity, including rhabdomyolysis. Patients who are currently tolerating the 40 mg dose of simvastatin who need to start an interacting drug that should not be taken with simvastatin or is associated with a dose cap for simvastatin should be switched to an alternative statin or statin-based regimen with less potential for the drug-drug interaction.
- Patients that require more than the 80 mg dose should be switched to an alternative drug.
Which drugs interact with atorvastatin and simvastatin?
A number of drugs reduce the body's ability to get rid of both Lipitor and Zocor. They include, but aren't limited to:
- erythromycin (E-Mycin),
- ketoconazole (Nizoral),
- itraconazole (Sporanox),
- clarithromycin (Biaxin),
- telithromycin (Ketek),
- cyclosporine (Sandimmune),
- nefazodone (Serzone), and
- HIV protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir).
Large quantities of grape fruit juice (more than 1.2 liters daily) also will increase blood levels of atorvastatin and simvastatin, so drink it sparingly.
The following drugs also may increase the risk of muscle toxicity when combined with Lipitor or Zocor.
- amiodarone (Cordarone)
- verapamil (Calan Verelan, Isoptin)
- cyclosporine (Sandimmune)
- niacin (Niacor, Niaspan, Slo-Niacin)
- gemfibrozil (Lopid)
- fenofibrate (Tricor)
A number of other drugs have reactions with Liptor and Zocor. This is not a complete list of drugs dangerous to combine with these statins, so make sure to tell your doctor about all the medications you are taking if they prescribe you atorvastatin or simvastatin.
Are atorvastatin and simvastatin safe to take during pregnancy or while breastfeeding?
Because cholesterol is vital to the formation of the fetus and the growth of infants, pregnant and nursing mothers should never take atorvastatin, simvastatin, or any other statin. The risk is so great, doctors won't prescribe statins to women of childbearing age unless they are unlikely to become pregnant.
Atorvastatin (Lipitor) and simvastatin (Zocor) are both statins that lower cholesterol levels in the bloodstream. These drugs, part of a family called statins, are prescribed to treat a large number of cardiovascular disease, including to prevent heart failure. Learn dosage, side effects, and pregnancy safety information before taking this drug.
Multimedia: Slideshows, Images & Quizzes
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Treatment & Diagnosis
Medications & Supplements
Daily Health News
Healthy Heart Resources
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
FDA Prescribing Information
"A Comparison of Simvastatin and Atorvastatin up to Maximal Recommended Doses in Large Multicenter Randomized Clinical Trial"
D. Roger Illingworth et. al
Current Medical Research and Opinion, 2001
"The 3-hydroxy-3-methylglutaryl coenzyme-A (HMG-CoA) reductases"
Jon A Friesen and Victor W Rodwell
Genome Biology, 2004
"Drug Class Review: HMG-CoA Reductase Inhibitors (Statins) and Fixed-dose Combination Products Containing a Statin: Final Report Update 5"
National Center for Biotechnology information
"Low-density lipoprotein receptor--its structure, function, and mutations"
Seminars in Vascular Medicine, 2004
"Statin inhibition of HMG-CoA reductase: a 3-dimensional view."
Atherosclerosis Supplements, 2003
"Effect of statins on HDL-C: a complex process unrelated to changes in LDL-C: analysis of the VOYAGER Database"
Philip J. Barter et. al
Journal of Lipid Research
"Good vs. Bad Cholesterol"
The American Heart Association
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Stroke is a serious medical condition. If you think you or someone you know is having a stroke call 911 immediately.
There are two main types of strokes, hemorrhagic and ischemic (the most common type).
A hemorrhagic stroke occurs due to a blood vessel rupture in the brain. An ischemic stroke occurs when a blood clot becomes lodged in a blood vessel in the brain, which causes a loss of blood supply to the brain, possibly causing brain tissue death.
FAST is an acronym that helps people identify stroke signs and symptoms so they can act fast and call 911. Face drooping, Arm weakness, and Speech difficulty are indicators that a person may be having a stroke and it is Time to seek emergency medical treatment. Additional signs and symptoms of stroke may include weakness, difficulty walking, blurred vision, dizziness, headache, confusion, difficulty speaking, and loss of sensation. .
Stroke is a major cause of death and disability in the US. Early identification and treatment of stroke helps reduce the risk of morbidity and mortality.
Angina SymptomsAngina is chest pain due to inadequate blood supply to the heart. Angina symptoms may include chest tightness, burning, squeezing, and aching. Coronary artery disease is the main cause of angina but there are other causes. Angina is diagnosed by taking the patient's medical history and performing tests such as an electrocardiogram (EKG), blood test, stress test, echocardiogram, cardiac CT scan, and heart catheterization. Treatment of angina usually includes lifestyle modification, medication, and sometimes, surgery. The risk of angina can be reduced by following a heart healthy lifestyle.
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Cholesterol ManagementHigh cholesterol and triglyceride levels increase the risk of cardiovascular disease. Getting your cholesterol and triglyceride levels in an optimal range will help protect your heart and blood vessels. Cholesterol management may include lifestyle interventions (diet and exercise) as well as medications to get your total cholesterol, LDL, HDL, and triglycerides in an optimal range.
Congestive Heart Failure (CHF) OverviewCongestive heart failure (CHF) refers to a condition in which the heart loses the ability to function properly. Heart disease, high blood pressure, diabetes, myocarditis, and cardiomyopathies are just a few potential causes of congestive heart failure. Signs and symptoms of congestive heart failure may include fatigue, breathlessness, palpitations, angina, and edema. Physical examination, patient history, blood tests, and imaging tests are used to diagnose congestive heart failure. Treatment of heart failure consists of lifestyle modification and taking medications to decrease fluid in the body and ease the strain on the heart. The prognosis of a patient with congestive heart failure depends on the stage of the heart failure and the overall condition of the individual.
Coronary Artery Disease Screening Tests (CAD)
Coronary heart disease or coronary heart disease (CAD) screening tests can be used to potentially prevent a heart attack or cardiac event in a person without heart disease symptoms, and can assist in diagnosing heart disease in individuals with heart disease symptoms. Examples of coronary heart disease tests include:
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- radionuclide stress test,
- stress echocardiography,
- pharmacologic stress test,
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HDL vs. LDL Cholesterol Differences
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Healthy (normal) total blood cholesterol levels are determined by the levels of HDL, LDL, and triglycerides in the blood. Talk with your doctor or other health care professional if you are concerned about your cholesterol levels, which can easily be determined with a simple blood test.
VLDL, or very-low- lipoproteins, is a third type of cholesterol. VLDL is another type of "bad" cholesterol that the liver produces, which contains a high amount of triglycerides.
REFERENCE: American Heart Association. "HDL (Good), LDL (Bad) Cholesterol and Triglycerides." Updated: Jul 05, 2017.
Heart Disease (Coronary Artery Disease)
Heart disease (coronary artery disease) occurs when plaque builds up in the coronary arteries, the vessels that supply blood to the heart. Heart disease can lead to heart attack. Risk factors for heart disease include:
- High blood pressure
- High cholesterol
- Family history
Angina, shortness of breath, and sweating are just a few symptoms that may indicate a heart attack. Treatment of heart disease involves control of heart disease risk factors through lifestyle changes, medications, and/or stenting or bypass surgery. Heart disease can be prevented by controlling heart disease risk factors.
Heart Disease in WomenHeart disease in women has somewhat different symptoms, risk factors, and treatment compared to heart disease in men. Many women and health professionals are not aware of the risk factors for heart disease in women and may delay diagnosis and treatment. Lifestyle factors such as diet, exercise, tobacco use, overweight/obesity, stress, alcohol consumption, and depression influence heart disease risk in women. High blood pressure, high cholesterol, and diabetes also increase women's risk of heart disease. Electrocardiogram (EKG or ECG), stress-ECG, endothelial testing, ankle-brachial index (ABI), echocardiogram, nuclear imaging, electron beam CT, and lab tests to assess blood lipids and biomarkers of inflammation are used to diagnose heart disease. Early diagnosis and treatment of heart disease in women saves lives. Heart disease can be prevented and reversed with lifestyle changes.
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Heart failure (congestive) is caused by many conditions including coronary artery disease, heart attack, cardiomyopathy, and conditions that overwork the heart. Symptoms of heart failure include
- congested lungs,
- fluid and water retention,
- fatigue and weakness, and
- rapid or irregular heartbeats.
There are two types of congestive heart failure, systolic or left-sided heart failure; and diastolic or right-sided heart failure. Treatment, prognosis, and life-expectancy for a person with congestive heart failure depends upon the stage of the disease.
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Peripheral Vascular Disease
Peripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis. Peripheral artery disease symptoms include intermittent leg pain while walking, leg pain at rest, numbness in the legs or feet, and poor wound healing in the legs or feet.
Treatment for peripheral artery disease include lifestyle measures, medication, angioplasty, and surgery.