Dear Dr. Roach: My doctor switched me from 20 mg atorvastatin to 20 mg pravastatin because I was having some muscle cramping and some mild neurological issues that might have been a side effect of the atorvastatin.

I still had these side effects with the pravastatin, but they were noticeably reduced. I also preferred the pravastatin, as it is supposedly less risky in terms of liver and kidney disease. Several of my friends developed diabetes after starting statin therapy, which also concerns me.

Unfortunately, the pravastatin did not work well enough to lower my LDL. Now I have a decision to make between increasing the pravastatin to 40 mg or going back to the 20 mg atorvastatin.

My LDL without statins is very high (150-180), with a total cholesterol of about 230-250. My LDL with 20 mg atorvastatin is 87. While on 20 mg pravastatin it was 149.

My doctor thinks either choice is fine. I’m probably making too much of an issue of this, but which do you think is the safer choice? — Anon.

Answer: Assuming you do not have known blockages in the arteries of your heart, I would be in favor of less side effects.

In a head-to-head trial in people with very severe blockages, atorvastatin with a goal LDL of less than 70 was more effective at preventing heart attacks than pravastatin with a goal LDL of 100. However, since you are using it for prevention, the additional benefit of atorvastatin probably adds very little benefit for you. I believe strongly that for prevention, it’s particularly important to find a treatment plan that does not cause undue side effects.

Liver and kidney problems due to any statin are quite unusual. All statins can precipitate diabetes in a person predisposed. However, most muscle aches noticed by people taking statins (of any type) are likely not due to the statin. Aches are just about as likely while taking a placebo pill as a statin.