From the Research
Atorvastatin should typically be discontinued if total cholesterol levels fall below 100 mg/dL (2.6 mmol/L), but the most recent and highest quality evidence suggests that the target level for discontinuation should be based on individualized cardiovascular risk assessment and LDL cholesterol levels, with a goal of achieving an LDL cholesterol level of around 30-50 mg/dL 1.
Considerations for Discontinuation
When considering discontinuation of atorvastatin, it's essential to take into account the patient's overall cardiovascular risk profile, including other lipid parameters like LDL cholesterol, HDL cholesterol, and triglycerides, as well as their medical history, especially any previous cardiovascular events or high-risk conditions like diabetes.
Importance of Individualized Care
Cholesterol management is individualized, and decisions should be made in partnership with a healthcare provider. The provider may recommend gradual tapering rather than abrupt cessation and will likely schedule follow-up lipid testing to monitor levels after stopping the medication.
Recent Recommendations
Recent studies suggest that fixed-dose statin treatment may not be effective for all patients, and that targeting specific LDL cholesterol levels may be more beneficial, especially for those with higher cholesterol levels 2. However, the most recent and highest quality evidence suggests that the goal should be to achieve an LDL cholesterol level of around 30-50 mg/dL, rather than a specific total cholesterol level 1.
Key Points to Consider
- Individualized cardiovascular risk assessment and LDL cholesterol levels should guide discontinuation decisions
- Gradual tapering rather than abrupt cessation may be recommended
- Follow-up lipid testing is essential after stopping the medication
- Recent recommendations emphasize the importance of targeting specific LDL cholesterol levels rather than fixed-dose statin treatment
- The goal should be to achieve an LDL cholesterol level of around 30-50 mg/dL, rather than a specific total cholesterol level 1