Atorvastatin calcium: PLACE IN THERAPY(4)
In recent years, the use of higher doses of HMG-CoA reductase inhibitors has been investigated in attempts to achieve greater reductions in plasma LDL-C levels, probably as a result of the evidence from the landmark studies. The WOSCOPS and CARE trials were conducted with the maximum approved dose of pravastatin (40 mg/day) . While 63% of patients in the 4S trial received simvastatin 20 mg/day for the entire study period, the dose was increased to 40 mg/ day within six months in the remaining patients in an attempt to achieve target values . Combination therapy has also been attempted to attain target LDL-C levels. In a trial designed to investigate the use of stepped care therapy for patients with normal cholesterol levels but with evidence of CAD, up to 70% of the patients required combination therapy (HMG-CoA reductase inhibitor plus resin and/or niacin) to reach a target LDL-C level of 2.6 mmol/L, despite receiving the maximum dose of HMG-CoA reductase inhibitor.
Although there are no data on the effect of atorvastatin-induced changes in lipoprotein levels on cardiovascular morbidity and mortality, the clinical trials data with atorvastatin suggest that the LDL-C reductions obtained in the studies discussed above (26% to 35%) can be achieved with the 10 mg/ day starting dose . Higher doses of atorvastatin resulting in even greater reductions in LDL-C (up to 60%) may be useful in patients requiring greater reductions in LDL-C levels (eg, patients with FH). Atorvastatin, therefore, appears to have the potential to achieve target LDL-C levels more readily and consequently may be a very useful agent as first-line therapy in patients with mild to moderate hypercholesterolemia, as well as for patients with severe hypercholesterolemia. buy asthma inhaler