What is the effect of Atorvastatin (HMG-CoA reductase inhibitor)?

From the Guidelines

Atorvastatin should be prescribed at a dose of 10-80 mg daily, with the goal of reducing LDL cholesterol levels and cardiovascular risk, as supported by the most recent and highest quality study 1. The medication works by inhibiting HMG-CoA reductase, an enzyme crucial for cholesterol production in the liver, thereby reducing LDL ("bad") cholesterol and triglycerides while slightly increasing HDL ("good") cholesterol. Some key points to consider when prescribing atorvastatin include:

• The typical starting dose is 10-20 mg once daily, which can be increased to a maximum of 80 mg daily if needed based on cholesterol response and tolerability.
• Atorvastatin should be taken at the same time each day, with or without food, and requires regular blood tests to monitor liver function and lipid levels.
• Common side effects include muscle pain, digestive issues, and mild liver enzyme elevations.
• Patients should report severe muscle pain immediately as this could indicate a rare but serious condition called rhabdomyolysis.
• Atorvastatin interacts with several medications including certain antibiotics, antifungals, and other cholesterol medications, so always inform healthcare providers about all medications you're taking.
• Lifestyle modifications including diet, exercise, and smoking cessation should accompany atorvastatin therapy for optimal cardiovascular benefit. It's also important to note that atorvastatin has been shown to reduce the risk of cardiovascular events, including stroke and myocardial infarction, in patients with established cardiovascular disease or at high risk of developing it 1. Additionally, the medication has been found to be effective in reducing LDL cholesterol levels in patients with hypercholesterolemia, including those with familial hypercholesterolemia 1. Overall, atorvastatin is a valuable medication for the management of cardiovascular risk and hypercholesterolemia, and its use should be guided by the most recent and highest quality evidence.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Atorvastatin Overview

• Atorvastatin is a synthetic hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, used to reduce levels of total cholesterol, low-density lipoprotein (LDL)-cholesterol, triglyceride, and very low-density lipoprotein (VLDL)-cholesterol, and increase high-density lipoprotein (HDL)-cholesterol in patients with dyslipidaemias 2.
• It is available in dosages of 10 to 80 mg/day and has been shown to be more efficacious than other HMG-CoA reductase inhibitors in achieving target LDL-cholesterol levels 2.

Efficacy and Safety

• Atorvastatin has been shown to be effective in reducing the incidence of major cardiovascular events, including death from coronary heart disease, nonfatal non-procedure-related myocardial infarction, resuscitated cardiac arrest, and fatal or nonfatal stroke 3.
• It is well tolerated, with adverse events usually being mild and transient, and has a tolerability profile similar to that of other available HMG-CoA reductase inhibitors and to placebo 2.
• Elevations of liver transaminases and creatine phosphokinase are infrequent, and there have been rare case reports of rhabdomyolysis occurring with concomitant use of atorvastatin and other drugs 2.

Clinical Benefits

• Atorvastatin provides pronounced lipid lowering in a broad range of individuals with hypercholesterolaemia and is an appropriate first-line therapy for patients at low to high risk of coronary heart disease 4.
• Reductions in total and low-density lipoprotein cholesterol achieved with atorvastatin have been shown to translate into reductions in risk of cardiovascular morbidity and mortality in both primary and secondary prevention settings 4.
• Significant clinical benefits have specifically been observed among patients with Type 2 diabetes and in those with acute coronary syndromes 4.

Dosage and Administration

• The dosage of atorvastatin can range from 10 to 80 mg/day, with the choice of dose depending on the individual patient's needs and response to treatment 2.
• High-dose atorvastatin (80 mg/day) has been shown to be effective in reducing the incidence of major cardiovascular events in patients 65 years of age or older with stable coronary heart disease 3.
• However, in a real-world US setting, a large number of high-risk cardiovascular patients did not attain guideline-recommended LDL-C levels with atorvastatin monotherapy, suggesting that more effective lipid-lowering strategies may be required 5.