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Both Crestor and Lipitor belong to a class of medications called statins. Crestor is the brand name for rosuvastatin, and Lipitor is the brand name for atorvastatin. The first member of this drug class that was approved by the FDA to treat high cholesterol was lovastatin, back in the late 1980s (Endo, 2010). In addition to these three, other statins on the market include Zocor (simvastatin), Pravachol (pravastatin), Lescol (fluvastatin), and Livalo (pitavastatin).
Statin medications act on a specific enzyme in the liver called hydroxymethylglutaryl-CoA (HMG-CoA) reductase. HMG-CoA reductase inhibitors block the enzyme’s ability to make cholesterol, resulting in lower cholesterol in the bloodstream (Sizar, 2020). Crestor and Lipitor also specifically lower LDL (“bad cholesterol”), raise HDL (“good cholesterol”), and improve triglyceride levels (types of fat molecules in the bloodstream).
High cholesterol and elevated triglycerides are major risk factors for the development of heart disease. Cholesterol and fats build up on the inside of blood vessels, causing atherosclerosis. This, in turn, leads to angina (chest pain), heart attacks, and strokes. In fact, heart disease is the leading cause of death for men and women in the United States (CDC, 2020). Crestor and Lipitor, along with diet and exercise, can help lower your risk of developing these life-threatening conditions. Over 27% of adults in the U.S. over the age of 40 are taking a statin medication (Salami, 2017).
Crestor vs. Lipitor
Crestor is made by AstraZeneca and is considered the most potent (strongest) statin. Like other statins, Crestor lowers total cholesterol, LDL cholesterol, and triglycerides while increasing HDL cholesterol. However, it causes significantly better reductions in total cholesterol at lower doses compared to the other drugs in this class (Jones, 2003). It is available in 5 mg, 10 mg, 20 mg, and 40 mg doses (both generic and brand name) and is typically taken once daily.
Common side effects include muscle aches (myalgia), headache, dizziness, nausea, and constipation. There have also been reports of memory problems and confusion in some people, along with elevation of blood sugar levels in people with diabetes (UpToDate-b, n.d.).
Muscle pain and weakness (myopathy) are more likely in people of Asian descent, and the elderly (UpToDate-b, n.d.). Pregnant or breastfeeding women should not take Crestor. A 30-day supply of Crestor will cost you around $243 (without insurance), while generic rosuvastatin is approximately $51 for a month’s supply.
Lipitor is made by Pfizer and is one of the most commonly prescribed statins in the U.S. (Salami, 2017). It is effective at reducing total cholesterol, LDL cholesterol, and triglycerides. Lipitor also increases HDL cholesterol. It is available in 10 mg, 20 mg, 40 mg, and 80 mg tablets that are typically taken once daily. Common side effects include joint pain, diarrhea, nasopharyngitis (think “common cold” symptoms), and, less commonly, muscle aches/pains (UpToDate-a, n.d.).
Less than 2% of people who take Lipitor have abnormal liver enzyme levels noted on liver function tests. Because of this, you should have blood tests to check your liver before starting this medication (UpToDate-a, n.d.). Rarely, people may have muscle breakdown (myopathy) that leads to liver damage and kidney failure (rhabdomyolysis). Lastly, a small percentage of people have a hemorrhagic stroke (bleeding in the brain), especially if they have had a recent stroke or are on a blood thinner. However, the overall benefit of taking a statin (decreased risk of stroke and heart disease) outweighs the risk of having a hemorrhagic stroke with Lipitor (UpToDate-a, n.d.).
You should avoid drinking large quantities of grapefruit juice if you are taking Lipitor as the grapefruit juice can increase the amount of the drug circulating in your system (UpToDate-a, n.d.). Pregnant or breastfeeding women should not take Lipitor. A 30-day supply of Lipitor will cost you around $207 (without insurance), while generic atorvastatin is approximately $17–$19 for a month’s supply.
Cholesterol medication: types, benefits, and side effects
Which is better for me?
Both Lipitor and Crestor are excellent medications to help improve high cholesterol and to decrease your risk of heart attacks and strokes. In studies, Crestor was more effective at lowering total cholesterol levels and raising HDL levels (Jones, 2003).
Despite this, there was no significant difference between the two drugs in how well they decreased the volume of atherosclerotic buildup in the arteries. Both Crestor and Lipitor are generally well tolerated with a similar rate of side effects. In the end, you should consult your healthcare provider to determine which one is right for you. Take into account cost, side effects, other medications you are taking, and any pre-existing conditions.
- Centers for Disease Control and Prevention (CDC). (2020). Heart Disease Facts. Retrieved July 17, 2020 from https://www.cdc.gov/heartdisease/facts.htm#:~:text=Heart%20disease%20is%20the%20leading,1%20in%20every%204%20deaths
- Endo, A. (2010). A historical perspective on the discovery of statins. Proceedings Of The Japan Academy, Series B, 86(5), 484-493. doi: 10.2183/pjab.86.484. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3108295/
- Jones, P., Davidson, M., Stein, E., Bays, H., McKenney, J., Miller, E. et al. (2003). Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR**STELLAR = Statin Therapies for Elevated Lipid Levels compared Across doses to Rosuvastatin. Trial). The American Journal Of Cardiology, 92(2), 152-160. doi: 10.1016/s0002-9149(03)00530-7. Retrieved from https://pubmed.ncbi.nlm.nih.gov/12860216/
- Salami, J. A., Warraich, H., Valero-Elizondo, J., et al. (2017). National Trends in Statin Use and Expenditures in the US Adult Population From 2002 to 2013: Insights From the Medical Expenditure Panel Survey. JAMA Cardiology, 2(1):56–65. doi:10.1001/jamacardio.2016.4700. Retrieved from https://jamanetwork.com/journals/jamacardiology/fullarticle/2583425
- Sizar, O., Khare, S., Jamil, R. T., Talati, R. (2020). Statin Medications. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK430940/
- UpToDate-a. (n.d.). Atorvastatin: Drug Information. Retrieved July 17, 2020 from https://www.uptodate.com/contents/atorvastatin-drug-information?search=lipitor&topicRef=4564&source=see_link#F137632
- UpToDate-b. (n.d.). Rosuvastatin: Drug Information. Retrieved July 17, 2020 from https://www.uptodate.com/contents/rosuvastatin-drug-information?search=crestor&source=panel_search_result&selectedTitle=1~62&usage_type=panel&kp_tab=drug_general&display_rank=1#F219489
Dr. Mike is a licensed physician and the Director, Medical Content & Education at Ro.