Top dose Atorvastatin cuts bad cholesterol by 50%, but what about smaller doses?

Key message: The effect of atorvastatin on lowering total cholesterol, LDL-cholesterol and triglyceride was proportional to the dose given. HDL-cholesterol was not significantly affected.

Atorvastatin is one of the most commonly prescribed drugs for preventing coronary heart disease. However, it is licensed in a large range of doses and there is uncertainty about the comparative effectiveness of these different doses. Also, there is often discord between clinicians and patients when discussing preventative medicines which give patients no day to day symptomatic benefit. Patients can have valid concerns about increased doses of Atorvastatin as there is a greater likelihood of side-effects and many patients prefer a “less rather than more” approach for their medications.

This new review included 33,504 participants in 254 trials assessing different doses of atorvastatin over a period of 3 to 12 weeks. The doses assessed ranged from 2.5mg to 80mg per day.

What did they find?

  • Total cholesterol was reduced 19.5% for 2.5mg, peak reduction was 38.7% for 80mg
  • LDL-cholesterol was reduced by 26.2% for 2.5mg and 53.5% for 80mg
  • HDL-cholesterol was not significantly affected
  • Triglycerides were reduced by 11.6% for 2.5mg and 32.1% for 80mg
  • The effect in each case was proportional to the dose

How good was the evidence?

  • There was a high risk of bias in many of the papers included, as many were not blinded, had limited sequence generation and allocation concealment
  • There was poor reporting of adverse events; therefore it was not possible to ascertain the incidence of adverse events with confidence
  • Approximately half of the trials were industry funded; half were funded by Pfizer (the manufacturer of atorvastatin) and half by other manufacturers
  • Publication bias was assessed as not significant

This review helps clarify the relationship between the dose of Atorvastatin and the effect it has on cholesterol levels, which will allow for a more factual and open discussion between clinicians and patients about the expected effects of their medication.

Link:

Adams SP, Tsang M,Wright JM. Lipid lowering efficacy of atorvastatin. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD008226. DOI: 10.1002/14651858.CD008226.pub2.

Editorial by Julian Higgins: Convincing evidence from controlled and uncontrolled studies on the lipid-loweringeffect of a statin. The Cochrane Library. 12 December 2012.  http://www.thecochranelibrary.com/details/editorial/3992221/Convincing-evidence-from-controlled-and-uncontrolled-studies-on-the-lipid-loweri.html

Author:

Harry Boardman

Harry Boardman

Harry was with the UK Cochrane Centre from October 2012 – May 2013, where he undertook a fellowship in systematic reviews. He is currently part way through his Cardiology specialist training within the Oxford Deanery and before this undertook his medical training in London. He is interested evidence based medicine within cardiology, particular in relation to cardiovascular risk in women, imaging and devices.

You can follow Harry on Twitter @harry9bo


Harry Boardman

About Harry Boardman

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Harry was with the UK Cochrane Centre from October 2012 – May 2013, where he undertook a fellowship in systematic reviews. He is now part way through a DPhil at the University of Oxford exploring pregnancy complications and future risk of heart disease in mothers. He is currently part way through his Cardiology specialist training within the Oxford Deanery and before this undertook his medical training in London. He is interested evidence based medicine within cardiology, particular in relation to cardiovascular risk in women, imaging and devices. You can follow Harry on Twitter @harry9bo

6 Comments on this post

  1. Avatar

    I have just been prescribed 20 m of atorvastatin per day . My blood cholesterol was 6,1 when last done a few weeks ago. So I ask what value would This give to me . 1%—2%-ext?. I have also just had a minor TIA , I Need to assess for myself the value of this medication.

    Lynn Schofield / Reply
  2. Avatar

    I was just put on medicine 10mg Atorvastatin, but i’m Wandering should I take every other day instead of one every day. I have change my diet and i’m Eating more of the foods to lower it. What do you think I should do.

    Redell Hall / Reply
    • Sarah Chapman

      I’m afraid we aren’t able to advise; you’d need to consult your doctor.
      Best wishes,
      Sarah Chapman [Editor]

      Sarah Chapman / (in reply to Redell Hall) Reply
  3. Avatar

    Higher doses of statins do reduce serum more than lower doses as the data above shows, however, the effect is far from linear. It takes more than thirty times as much statin to double the lipid lowering. Worse yet, there is no data at all that shows increasing statin dose reduces heart attack risk more than a low dose. Who cares about halving one’s lipid level if it cannot be correlated with a reduction in heart attack risk? There is no dose-response data. If lipid lowering really did reduce heart attack risk it ought to be easy to demonstrate a direct relationship between dose amount and heart attack incidence. In spite of the enormous time and money spent on such research nothing of the sort has been found. If statins reduce heart attack rates, and the Cochrane Collaboration study on statins does suggest a very, very small reduction, it is most likely due to some other effect than lipid lowering.

    Robert Bramel / Reply
  4. Avatar

    Ellisbriony, I’m interested in what you say about these medicines should be limited to a small number. Do you mean that we should only prescribe a small number of different statin drugs (i.e. simvastatin, atorvastatin, rosuvastatin etc.) or the number of patients who are prescribed a statin should be limited?

    hboardman2012 / Reply
  5. Avatar

    Atorvastatin is commonly used to prevent heart disease. These medicines should be limited to a small number.

    Ellisbriony / Reply

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