Following this approach, we recommend three Best Buys depending on your LDL target and overall health:

 - Generic lovastatin or pravastatin—if you need to lower LDL by less than 30 percent.

 - Generic simvastatin (20mg or 40mg)—if you need 30 percent or greater LDL reduction and/or you have heart disease or diabetes, or if you have had a heart attack but your LDL is not very high.

 - Lipitor (40mg or 80mg)—if you've had a heart attack and your LDL is 40 percent or more above the desired level.

As you can see from the table at left, brand-name Lipitor will run you an average of $145 a month. But the generics we recommend are good values—and especially lovastatin at less than $20 a month. Some stores with discount generic drug programs offer lovastatin and pravastatin for less than $15 a month. They include Costco, Safeway, Target, Walgreens, and Walmart.

If you start taking lovastatin or pravastatin and your LDL doesn't drop after a few months, talk to your doctor about switching to simvastatin. Another alternative is to add a non-statin drug, such as Questran, Welchol, or niacin. All three have drawbacks, though, that you should ask your doctor about (niacin, for example, can cause hot flashes and flushing). Most importantly, while these drugs lower LDL, none have been proven to reduce heart attacks or strokes. We don't recommend Advicor or Simcor (at $75 to $145 per month) since, if your doctor recommends adding niacin to your regimen, it's available as an inexpensive generic (under $15 per month). It's also available as an over-the-counter supplement, though you should only buy "USP-verified" brands. By combining a generic statin with generic niacin, you can save some $50 to $100 a month as compared to what you'd spend for one of the branded combination drugs.

Our one branded Best Buy—Lipitor—was selected largely based on evidence that it can help people who've already had a heart attack. This doesn't mean the other statins wouldn't do the same, but the evidence for Lipitor is quite strong. If your doctor prescribes Lipitor, we recommend you take it for a year or two and then either reconfirm your need for Lipitor or switch to a generic version of simvastatin. Incidentally, if you do stick with Lipitor, you or your insurer will probably get some financial relief when the drug goes generic in 2011.

The combination drug Vytorin deserves a special note. A clever ad campaign over the past three years propelled awareness and sales of the drug. Alas, Vytorin has now become another "poster child" for possible drug oversell. Evidence released in early 2008 suggests that it's no more effective than simvastatin alone. Pending further studies, we suggest avoiding Vytorin and choosing generic simvastatin instead if you need a more potent drug.