A meta-analysis including 71,108 people, 36,062 on statins and 35,046 on placebo, reported the greatest risk of SAMS with atorvastatin and the least risk with fluvastatin. Different rates have been attributed to pharmacological differences between statins. For example, rosuvastatin and pravastatin are primarily metabolized by cytochrome 2C9, a site with fewer drug-drug interactions than cytochrome 3A4, which metabolizes simvastatin, lovastatin and atorvastatin.