A Cochrane review [Abstract] 1 included 296 studies with a total of 38 817 subjects (242 before-and-after trials and 54 placebo-controlled trials). Included studies evaluated the dose-related efficacy of atorvastatin during 3 to 12 weeks. Log dose-response data revealed linear dose-related effects on blood total cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides. There was a 3.6%, 4.9% and 3.8% decrease in blood total cholesterol, LDL-cholesterol and triglycerides, respectively, for every two-fold dose increase. For every two-fold dose increase, the HDL-cholesterol increasing effect of atorvastatin diminished by 0.9%. The slope of dose-related effects on cholesterol and LDL-cholesterol was similar for atorvastatin and rosuvastatin, but rosuvastatin is about three-fold more potent. Subgroup analyses suggested that the atorvastatin effect was greater in females than in males and was greater in non-familial than in familial hypercholesterolaemia. Table T1 shows the effect of atorvastatin on LDL cholesterol over the manufacturer recommended dose range of 10 to 80 mg/day.
| Intervention | Participants (studies) | Percent change from baseline (95% CI) |
|---|---|---|
| Atorvastatin 10 mg/day | 21 941 (188) | -37.1% (-37.3 to -36.9%) |
| Atorvastatin 20 mg/day | 9 310 (80) | -42.3% (-42.6 to -42.0%) |
| Atorvastatin 40 mg/day | 3 296 (37) | -47.4% (-48.0 to -46.9%) |
| Atorvastatin 80 mg/day | 4 281 (37) | -51.7(-52.2 to -51.2%) |
The review did not provide a good estimate of the incidence of harms associated with atorvastatin because of the short duration of the trials and the lack of reporting of adverse effects in 37% of the placebo-controlled trials. All doses of atorvastatin did not change withdrawals due to adverse effects as compared to placebo (RR 0.98, 95% CI 0.68 to 1.40).
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