Statins have been available for only 14 years, not long enough to conclusively establish their safety. They do pose a slight risk of liver damage, and patients need blood tests during the first few months to make sure that's not happening. But most physicians feel the danger is slight. As the safety issue has receded, the definition of patients who might benefit from a statin has broadened. Many physicians reach for the prescription pad more readily than that.
Most clinical researchers believe that all statins work pretty much the same way.
Roughly half the cholesterol that circulates in the blood is generated by the liver, and the drugs employ a natural or synthetic form of a substance derived from a fungus to block an enzyme the liver needs to produce cholesterol. That slashes LDL, the major villain in the development of heart disease because it deposits fatty particles inside the walls of the coronary arteries. Depending on the choice and dose of statin, LDL levels can drop by about 15 percent to 40 percent. The drugs also lift HDL by smaller amounts, which reduces risk because HDL carries fatty particles out of the bloodstream and back to the liver for elimination. Lipitor, the newest statin, might seem to be the obvious choice because it's the best at reducing LDLs.