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Atorvastatin (Lipitor) Medication Overview for Heart Health
Atorvastatin, or Lipitor, belongs to a class of medications known as HMG-CoA reductase inhibitors, also known as statins. Statins work to lower lipid levels in the body. Lipids are fats found in the blood and include things like cholesterol and triglycerides. When you have high lipid levels, you are at increased risk for things like stroke, heart attack, and other cardiovascular issues. Because atorvastatin lowers lipid levels, it prevents coronary heart diseases that lead to downstream complications and death.
Because of its mechanism of action, atorvastatin is indicated for both primary and secondary prevention of coronary heart disease. It also has several other uses approved by the Food and Drug Administration (FDA) that are related to dyslipidemia.
Medical Indications
Atorvastatin (Lipitor) is used as an adjunct to proper diet to do the following for do lower cholesterol and for heart health:
- Lower risk of heart attack, stroke, angina, and revascularization procedures in those without coronary heart disease but with several risk factors
- Lower risk of heart attack and stroke in individuals with type II diabetes without coronary heart disease but with several risk factors
- Lower risk of non-fatal heart attack, non-fatal and fatal stroke, angina, revascularization procedures, and coronary heart disease hospitalization in patients with coronary heart disease
- Lower increased cholesterol and triglyceride levels in adult individuals with primary hyperlipidemia and mixed dyslipidemia
- Lower increased triglycerides in individuals with hypertriglyceridemia and primary dysbetalipoproteinemia
- Lower total cholesterol levels in individuals with homozygous familial hypercholesterolemia (HoFH)
- Lower cholesterol and apo B levels in adolescents with heterozygous familial hypercholesterolemia after failing diet treatment (2)
Although all these indications may be confusing, they all share one commonality: lowering lipid levels to prevent downstream complications.
Dosage and Administration of Atorvastatin (Lipitor) for Heart Health
Atorvastatin (Lipitor) used for heart health comes in several strengths, including 10, 20, 40, and 80 mg strength tablets. You can take this medication with or without foods, but make sure to take it at the same time each day. Although you can take it whenever, some experts recommend taking it at night as cholesterol production levels are highest at night (1).
Your dose of atorvastatin will be selected to you by your provider depending on your individual health history and other factors. Always take your atorvastatin as directed by your doctor. The typical starting dose is either 10 or 20 mg once a day, but your dose can range from 10 to 80 mg once a day (2).
Statin Benefit Groups
The American College of Cardiology and American Heart Association Guidelines (ACC/AHA) outline target doses based on which statin benefit group you fall into. For those on moderate-intensity statin therapy, an atorvastatin (Lipitor) used for heart health dose of 10 to 20 mg should suffice, which is expected to lower LDL cholesterol (LDL-C) by 30 to 50 percent. For those on high-intensity statin therapy, an atorvastatin dose of 40 to 80 mg is routine, which is expected to lower LDL-C by more than 50 percent.
Dosing for pediatrics is different. The FDA has approved atorvastatin for pediatrics with a starting dose of 10 mg once a day and maximum dose of 20 mg once a day. There are no additional dosing recommendations for other special patient populations, such as the elderly or those with kidney issues.
Potential Side Effects
Atorvastatin (Lipitor), used for heart health, can cause several side effects. Common side effects, meaning those occurring in more than two percent of individuals, include diarrhea, urinary tract infection (UTI), arthralgia, common cold, joint pain, and extremity pain (2). Atorvastatin may also cause more serious side effects, which are outline below:
- Myopathies/rhabdomyolysis. Myopathies are conditions that affect your skeletal muscle and include things like muscle pain, weakness, and tenderness. This is accompanied by increased creatine phosphokinase, which is ten times the upper limit of normal. In addition, rhabdomyolysis can occur, which is a severe condition characterized by damaged muscle that produces electrolytes and proteins in the blood.
- This can cause injury to your kidneys or heart, resulting in serious complications or death. Your risk of muscle complications is increased with kidney impairment or concomitant use of certain medications.
- Liver problems. Statins like atorvastatin may cause marked increases in liver enzyme levels.
- Diabetes. Statins may increase blood sugar levels or glycosylated hemoglobin. Despite this, the ACC/AHA still believe the benefits of statin therapy outweigh the risk for diabetes.
- Stroke. Clinical studies show that there is a higher risk of stroke in patients without coronary heart disease who had previously had a stroke within the last six months.
Precautions and Contraindications of Atorvastatin (Lipitor) for Heart Health
Because of its potential effect on liver enzymes, atorvastatin should be used cautiously in individuals with a history of liver disease or who drink excessively. Patients with active liver disease should not take atorvastatin.
Additionally, atorvastatin is contraindicated in patients who are pregnant, patients who may become pregnant, nursing mothers, or those who have an allergy to the components of the medication.
Interactions
Caution should be taken when taking atorvastatin with other medications that may increase one’s risk of myopathy. This risk is increased with:
- Niacin
- Cyclosporine
- Fibric acid derivatives
- Strong CYP3A4 inhibitors (e.g., clarithromycin, itraconazole, HIV medications)
Other medications that may interact with atorvastatin include digoxin and oral birth control. Atorvastatin may also interact with grapefruit juice, which is also a CYP3A4 inhibitor.
Effectiveness and Expectations of Atorvastatin (Lipitor) for Heart Health
Several trials have evaluated the efficacy of atorvastatin for lowering lipid levels and preventing heart disease. One such study was the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), in which atorvastatin was studied in over 10,000 individuals with high cholesterol levels. Findings demonstrated that atorvastatin was associated with significant decreases in coronary events and non-fatal heart attack. This decrease in risk was estimated to be roughly 36 percent.
Other studies have more closely evaluated atorvastatin’s ability to lower cholesterol and triglyceride levels. Lipitor has been shown to decrease total cholesterol, LDL-C, apo B, VLDL, and triglycerides and increase HDL-C in individuals with mixed dyslipidemia and hyperlipidemia.
Long-Term Use and Monitoring of Atorvastatin (Lipitor) for Heart Health
To ensure that atorvastatin (Lipitor) for heart health therapy is safe for the liver, individuals should receive baseline liver function tests. These should be repeated as needed to ensure that liver enzyme levels are normal and within range.
Additionally, to confirm atorvastatin efficacy, patients should get a baseline lipid panel. This lipid panel should be repeated after six weeks of treatment to ensure that lipid levels have lowered appropriately. When your lipids become stable, they should be checked again every six to 12 months.
In those with diabetes or those at high risk for diabetes, monitoring of blood glucose levels may be indicated.
Alternatives and Complementary Therapies of Atorvastatin (Lipitor) for Heart Health
There are other pharmacologic and herbal therapies that can also help to lower cholesterol levels. Other pharmacologic therapies include:
- Fibrates. Fibrates can decrease triglyceride levels and may have a modest effect (about 15 to 20 percent reduction) on cholesterol levels. However, fibrates do not seem to lower your risk of stroke and heart attack. Thus, they are not a full alternative to statins.
- Niacin. Some research suggests that niacin can reduce bad cholesterol and increase good cholesterol. However, like fibrates, they do not decrease your risk of stroke or heart attack, and thus are not a good alternative to statins.
- Cholestyramine. Cholestyramine, along with other bile acid-binding resins, are not used much anymore because of their inability to lower heart attack and stroke risk (3).
Complimentary Lifestyle Therapies to Use With Atorvastatin (Lipitor) for Heart Health
Atorvastatin should always be used in adjunct to diet to lower cholesterol. The American Heart Association (AHA) suggest that you limit saturated fat in your diet to less than six percent of your total daily calories. In addition, you should avoid trans fat when possible. This means avoiding things like dairy, red meat, and fried foods.
Other complementary therapies involve engaging in regular exercise. Incorporating 150 minutes of moderate-intensity aerobic workouts can benefit both your blood pressure and cholesterol levels. There are several ways to do this, including cycling, quick walking, and swimming. Regular exercise and a proper diet together can help you to lose weight. Thankfully, weight loss of five to 10 percent of body weight can significantly improve your cholesterol levels.
If you smoke or vape, you should consider quitting. Both smoking and vaping lower your good cholesterol. By stopping, you can decrease your bad cholesterol while increasing your good cholesterol. Quitting smoking also has several other benefits outside of just cholesterol levels.
Frequently Asked Questions (FAQs) for Atorvastatin (Lipitor) for Heart Health
What do I do if I get side effects from atorvastatin (Lipitor)?
If you experience side effects from atorvastatin, discuss these with your doctor. Your provider may lower your dose or change you to a different type of statin.
How long will I be on atorvastatin (Lipitor) for?
You are typically on statins for the rest of your life to ensure that your cholesterol levels are maintained at a healthy level.
How do I know if atorvastatin (Lipitor) is working?
We cannot feel what our cholesterol levels, so it is difficult to know if atorvastatin is working unless you get blood tests. After six weeks of therapy, you should get your cholesterol levels checked to ensure that atorvastatin is working.
Resources
- https://www.ncbi.nlm.nih.gov/books/NBK430779/#:~:text=For%20patients%20with%20coronary%20heart,congestive%20heart%20failure%2C%20and%20angina.
- https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020702s056lbl.pdf
- https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/cholesterol-lowering-alternatives
- https://www.heart.org/en/health-topics/cholesterol/prevention-and-treatment-of-high-cholesterol-hyperlipidemia#:~:text=The%20American%20Heart%20Association%20recommends,fat%2Dfree%20dairy%20products%20instead.