An updated review on the effects of varying doses of atorvastatin on serum total cholesterol, low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL)- cholesterol, and triglycerides in patients with and without evidence of cardiovascular disease confirms previous evidence of the drug’s dose-related effects on blood lipids.
Published in the Cochrane Review, the authors added an additional 42 trials to the review that was first published in 2012, bringing the total number of randomized controlled and uncontrolled before-and-after trials evaluating the dose response of different fixed doses of atorvastatin on blood lipids over a duration of three to 12 weeks to 296. The primary objective was to survey the effects of various doses of atorvastatin (10–80mg/day) on serum total cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides in patients with and without evidence of cardiovascular disease; secondary objectives included the variability of effects of various doses of atorvastatin and withdrawals due to adverse effects (WDAEs).
The new evidence did not differ significantly from the 2012 review although the new results do significantly increase the strength of the evidence. With the 10-80 mg/day range, LDL-cholesterol was decreased by 37.1% to 51.7% in a predictable dose-dependent manner. However, new findings suggest that atorvastatin is less potent than rosuvastatin but the slope of dose-related effects on cholesterol is similar, the cholesterol-lowering effects are greater in females vs. males, and the drug is more effective in non-familial hypercholesterolaemia compared to familial. Due to the short duration of most trials and adverse effects only being reported in 37% of placebo-controlled trials, reliable estimates are not available. The WDAEs reported were not statistically significant between atorvastatin and placebo groups.
Even with these results, the authors conclude that more RCTs are needed to expand the estimate of dose-response efficacy and reporting of WDAEs.
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