Lipid lowering efficacy of atorvastatin (Review)

Adams SP, Tsang M, Wright JM

This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library
2012, Issue 12
http://www.thecochranelibrary.com

Lipid lowering efficacy of atorvastatin (Review)

Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
[Intervention Review]

Lipid lowering efficacy of atorvastatin

Stephen P Adams1 , Michael Tsang2 , James M Wright1

1 Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada. 2 Department
of Internal Medicine, Internal Medicine Residency Office, Faculty of Medicine, McMaster University, Hamilton, Canada

Contact address: Stephen P Adams, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia,
2176 Health Sciences Mall, Medical Block C, Vancouver, V6T 1Z3, Canada. stevenad@mail.ubc.ca.

Editorial group: Cochrane Heart Group.

Publication status and date: Edited (no change to conclusions), published in Issue 3, 2014.
Review content assessed as up-to-date: 30 November 2011.

Citation: 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.

Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

ABSTRACT

Background

Atorvastatin is one of the most widely prescribed drugs and the most widely prescribed statin in the world. It is therefore important to
know the dose-related magnitude of effect of atorvastatin on blood lipids.

Objectives

To quantify the dose-related effects of atorvastatin on blood lipids and withdrawals due to adverse effects (WDAE).

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library Issue 4, 2011, MEDLINE
(1966 to November 2011), EMBASE (1980 to November 2011), ISI Web of Science (1899 to November 2011) and BIOSIS Previews
(1969 to November 2011). No language restrictions were applied.

Selection criteria

Randomised controlled and uncontrolled before-and-after trials evaluating the dose response of different fixed doses of atorvastatin on
blood lipids over a duration of 3 to 12 weeks.

Data collection and analysis

Two review authors independently assessed trial quality and extracted data. WDAE information was collected from the placebo-
controlled trials.

Main results

Two hundred fifty-four trials evaluated the dose-related efficacy of atorvastatin in 33,505 participants. Log dose-response data revealed
linear dose-related effects on blood total cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides. Combining all the
trials using the generic inverse variance fixed-effect model for doses of 10 to 80 mg/day resulted in decreases of 36% to 53% for LDL-
cholesterol. There was no significant dose-related effects of atorvastatin on blood high-density lipoprotein (HDL)-cholesterol. WDAE
were not statistically different between atorvastatin and placebo for these short-term trials (risk ratio 0.99; 95% confidence interval
0.68 to 1.45).
Lipid lowering efficacy of atorvastatin (Review)
Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Authors’ conclusions
Blood total cholesterol, LDL-cholesterol and triglyceride lowering effect of atorvastatin was dependent on dose. Log dose-response
data was linear over the commonly prescribed dose range. Manufacturer-recommended atorvastatin doses of 10 to 80 mg/day resulted
in 36% to 53% decreases of LDL-cholesterol. 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.

PLAIN LANGUAGE SUMMARY

The effect of atorvastatin on blood lipids
Atorvastatin is one of the most widely consumed drugs and the most widely consumed drug in the statin class in the world. It is
therefore important to know the magnitude of effect that atorvastatin has on blood lipids. We searched for all the trial evidence from
3- to 12-week trials reporting the effect of atorvastatin on blood lipids. We found 254 trials in 33,505 participants. Atorvastatin had
a consistent effect to lower blood total cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides over the dose range of
2.5 to 80 mg daily. The effect was greater with higher doses than with lower doses. Manufacturer-recommended atorvastatin doses of
10 to 80 mg/day resulted in 36% to 53% decreases of LDL-cholesterol. Adverse effects of atorvastatin were not evident in these short-
term trials but adverse effects were not reported in 37% of the trials.

Lipid lowering efficacy of atorvastatin (Review)

Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.