Atorvastatin I
Atorvastatin is the flagship of the Statin group of medicines, which is used to prevent cholesterol buildup in arteries. When used in the right people it can decrease the chance of heart attack and stroke by up to forty five percent, but obviously it’s not for everyone, because there is the potential for significant side effects. It is a generic and inexpensive medication. It was called Lipitor until the patent ran out. Doses usually range from 10 milligrams per day up to 80 milligrams per day. The higher doses like 40 and 80 mg per day are felt to be more protective. It works by decreasing the LDL, or bad cholesterol, and possibly by other means.
There are two main groups of people where a statin can be useful. The first is people who have had a stroke, heart attack or other blood vessel problem. Atorvastatin can be used to help prevent another one from occurring. It’s really quite well proven in this group of people to be helpful. The second group is people who have a moderate to high chance of having a stroke or heart attack but they haven’t had one yet. The medicine isn’t as well proven in this setting, but at this time, doctors are encouraged to use atorvastatin for people who have moderate to high chance of stroke or heart attack. I’ll go into more depth about who should be on atorvastatin in the Atorvastatin II video.
The biggest concern most people have about atorvastatin is the side effects. Here’s a chart that gives the approximate chance of different side effects from happening. Muscle aching is the most common side effect. This could be in the shoulders, the legs, the buttocks, pretty much anywhere could start to hurt. It happens in about one in five people, in my experience. Sometimes it’s quite mild, and the medicine doesn’t have to be stopped, but frankly, in most people with muscle aches, I end up stopping the medication. Another side effect is tendonitis. It happens in about 1 in 50 people, so less common than muscle aches, and that’s going to involve the tendons of the ankles, wrists, elbows, again, basically anywhere. A third side effect, which is a dangerous one which I’ve seen on a couple of occasions, is rhabdomyolysis. This is a problem with the muscle cells where the medication causes the muscle cells to be damaged, and they leak their contents out into the bloodstream. This can poison the kidneys and cause a person to end up on dialysis and it can really be a major problem. Fortunately, it’s infrequent. It happens in about one in twenty five thousand people on the medication. Another common side effect is a non-permanent liver inflammation. This will show up on a blood test that is abnormal. It’s usually not dangerous and we either decrease the dose or stop the medication, and switch it to a different Statin (like Rosuvastatin or Pravastatin) when this happens. Liver failure is a bad side effect you hear a lot about with the medicine, but it is extremely uncommon, and happens in about one in a million people who take it. Diabetes is diagnosed in one out of 250 people on Atorvastatin. So this is listed as a side effect.
I think it’s helpful to look at the things that atorvastatin doesn’t cause at this point. It doesn’t look like it causes dementia or cancer at all. Also, I think it helps to think about the chance that the medicine is going to help someone as compared to the chance that it’s going to hurt him or her. It has a 1 in 10 to 1 in 5 chance of preventing stroke heart attack or death, and it has about a one in five chance of causing muscle aches. Those are pretty similar odds, for the medication to cause muscle aches or for it to prevent a heart attack or stroke. Obviously, a stroke or heart attack is much, much worse than a temporary case of muscle aches that will go away when the medicine is stopped. When muscle aches occur, we decrease the dose, switch the medicine, or stop it and the muscle aches go away, so a concern about muscle aches isn’t really a good reason to avoid starting atorvastatin. The dangerous side effects of atorvastatin, the possibly life-threatening ones, occur only in one in many thousands of people, so there’s a very low chance of that happening and a much higher chance of the medicine helping a person, and that’s why we use it so much. Unfortunately, though, the risk of major side effects is real, and I have seen them, but the chance that a person will benefit from the medicine is generally much greater than the chance that it will hurt them, as long as it’s being used in the right people. Please see my Atorvastatin II article for a discussion of who should be on the medication.
