The safety profile of atorvastatin is comparable with that of other HMG-CoA reductase inhibitors. Atorvastatin is generally well tolerated, and adverse reactions have usually been mild and transient. As with the other HMG-CoA reductase inhibitors, the most frequent adverse events reported for ator-vastatin were constipation, flatulence, dyspepsia and abdominal pain.
Comparative data from multicentre, randomized, clinical trials demonstrate that, at a starting dose of 10 mg/day, ator-vastatin produces greater reductions in LDL-C levels (and total cholesterol levels) than those observed with the starting doses of other HMG-CoA reductase inhibitors. Higher doses of atorvastatin are more effective than equivalent doses of other HMG-CoA reductase inhibitors and offer the option of greater reductions in lipoprotein levels in patients requiring this. More patients reach treatment goals with atorvastatin than with other HMG-CoA reductase inhibitors. The efficacy of atorvastatin is similar between men and women and between young and elderly patients.
Other studies evaluating costs associated with atorvasta-tin treatment are underway. As discussed earlier, several long term studies are in progress evaluating outcomes in cardiovascular events (such as incidence rates of cardiac death, non-fatal MI and surgical procedures), and these studies will also include economic assessments.
Comparison of price on the basis of a cost per percentage of cholesterol (specifically LDL-C) reduction has also been evaluated in the literature as an appropriate measure for evaluating treatment for similar degrees of cholesterol (LDL-C) reduction . This measure essentially equalizes the differences in efficacy and cost, comparing direct drug costs only. Application of this procedure to efficacy data obtained from the only prospective, randomized, clinical trial comparing available HMG-CoA reductase inhibitors resulted in atorvastatin (10 mg/day) providing the lowest cost (in American dollars) per percentage of LDL-C reduction . Applying Canadian drug costs to such an analysis also shows that atorvastatin has the lowest cost per percentage of LDL-C lowering compared with available HMG-CoA reductase inhibitors (Table 9).
In some patients with homozygous FH, treatment includes LDL apheresis . In severe cases, adjunctive drug therapy is often tried in attempts to further lower LDL-C levels. Clinical data with atorvastatin have shown that at high doses (up to 80 mg/day), significant reductions in LDL-C were observed in such patients, including in some patients with absent LDL receptor function . Atorvastatin may thus be a useful agent as adjunctive therapy with LDL aphere-sis in patients with homozygous FH. asthma inhalers
Atherogenic dyslipidemia’ has been suggested to be a dyslipidemic syndrome characterized by specific abnormalities in the lipoprotein profile: borderline-high LDL-C levels, elevated triglyceride levels, low HDL-C levels and the presence of small, dense, LDL particles . These abnormalities often occur together and have been suggested to impart a risk of CAD at least equal to that of primary hypercholesterolemia (ie, increased LDL-C). Atorvastatin, with its unique ability to affect the lipoprotein fraction most available, may be a useful first-line agent for the treatment of this syndrome. Clinical trial results have shown that atorvastatin significantly lowers LDL-C and triglyceride levels, and raises HDL-C levels. Additionally, in one study, atorvastatin was reported to reduce small, dense, LDL particle size in patients with combined (mixed) hyperlipidemia ; however, further studies are required to verify this.
Other available treatment options often are not adequate as monotherapy for patients with elevated LDL-C and triglyceride levels (ie, combined [mixed] dyslipidemia or Fredrickson type Ilb dyslipidemia) . These patients require significant reductions in triglyceride and LDL-C levels. Whereas available statins lower LDL-C levels, they are only moderately effective in reducing triglyceride levels . On the other hand, fibric acid derivatives and niacin significantly reduce triglycerides but only modestly lower LDL-C levels. flovent inhaler