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Evidence summaries

Lipid Lowering Efficacy of Atorvastatin

Atorvastatin is effective at lowering blood LDL-cholesterol concentrations and does so in a predictable dose-related manner. Level of evidence: "A"

Summary

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.

LDL-cholesterol lowering efficacy of atorvastatin

InterventionParticipants (studies)Percent change from baseline (95% CI)
Atorvastatin 10 mg/day21 941 (188)-37.1% (-37.3 to -36.9%)
Atorvastatin 20 mg/day9 310 (80)-42.3% (-42.6 to -42.0%)
Atorvastatin 40 mg/day3 296 (37)-47.4% (-48.0 to -46.9%)
Atorvastatin 80 mg/day4 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).

Clinical comments

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    References

    • Adams SP, Tsang M, Wright JM. Lipid-lowering efficacy of atorvastatin. Cochrane Database Syst Rev 2015;(3):CD008226. [PubMed].

Primary/Secondary Keywords