491 Higher doses of atorvastatin reduce cholesterol more than lower doses

December 02, 2016

written by Brian R McAvoy

Clinical question
How effective are various doses of atorvastatin on serum total cholesterol (TC), low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)-cholesterol and triglycerides in individuals with and without evidence of cardiovascular disease?

Bottom line
Atorvastatin 2.5–80mg/day caused a reduction in TC, LDL-cholesterol and HDL-cholesterol, and triglycerides. Manufacturer-recommended atorvastatin doses of 10–80mg/day resulted in 37.1% to 51.7% decreases in LDL-cholesterol. For every 2-fold increase in dose, there was a 3.6% and 4.9% decrease in TC and LDL-cholesterol, respectively. The effect was greater in females than in males, and was greater in non-familial than in familial hypercholesterolaemia.

Caveat
This review update did not provide a good estimate of the incidence of harms associated with atorvastatin use because included trials were of short duration (3–12 weeks) and adverse effects were not reported in 37% of placebo-controlled trials. At the present time, there is nothing to suggest one statin is different to another statin in terms of the benefit in reduction of atherosclerotic-related events.

Context
Atorvastatin is one of the most widely-prescribed drugs and the most widely prescribed statin worldwide. This updated review significantly increases the strength of the evidence for the effectiveness of atorvastatin.

Cochrane Systematic Review
Adams SA et al. Lipid-lowering efficacy of atorvastatin. Cochrane Reviews, 2015, Issue 3. Art. No.: CD008226.DOI: 10.1002/14651858. CD008226.pub3. This review contains 296 studies involving 38,817 participants.

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