From the Research
Atorvastatin therapy should be initiated when total cholesterol levels are above 200 mg/dL (5.2 mmol/L), especially if LDL cholesterol is elevated, as part of a comprehensive cardiovascular risk assessment. The decision to start atorvastatin should be based on factors including:
- LDL cholesterol level (primary target)
- Age
- Blood pressure
- Smoking status
- Family history of cardiovascular disease
- Presence of diabetes or other risk factors Initial dosing usually starts at 10-20 mg daily, taken at any time of day, and can be adjusted after 2-4 weeks based on lipid panel results and tolerability 1. Atorvastatin works by inhibiting HMG-CoA reductase, the rate-limiting enzyme in cholesterol synthesis, thereby reducing cholesterol production in the liver and increasing LDL receptor expression, which enhances cholesterol clearance from the bloodstream. According to the most recent study 2, there is evidence that high LDL cholesterol levels cause atherosclerotic heart disease, and current guidelines recommend an LDL cholesterol target of 70 mg/dL for patients at high or very high risk. Before starting treatment, baseline liver function tests should be performed, and patients should be advised about potential side effects, particularly muscle pain, and instructed to report any unusual symptoms promptly. The goal of atorvastatin therapy is to achieve an LDL cholesterol level < 70 mg/dL, as recommended by current guidelines, although this target is often not met in clinical practice 3. It is also important to note that very low LDL cholesterol levels (below 40 mg/dL) have been associated with a very low risk of cardiovascular disease, and high-intensity statin therapy can achieve these levels without a significant increase in adverse events 2, 4.