Atorvastatin Calcium (Page 8 of 11)
14.2 Hyperlipidemia and Mixed Dyslipidemia
Atorvastatin reduces total-C, LDL-C, VLDL-C, apo B, and TG, and increases HDL-C in patients with hyperlipidemia (heterozygous familial and nonfamilial) and mixed dyslipidemia ( Fredrickson Types IIa and IIb). Therapeutic response is seen within 2 weeks, and maximum response is usually achieved within 4 weeks and maintained during chronic therapy.
Atorvastatin is effective in a wide variety of patient populations with hyperlipidemia, with and without hypertriglyceridemia, in men and women, and in the elderly.
In two multicenter, placebo-controlled, dose-response studies in patients with hyperlipidemia, atorvastatin given as a single dose over 6 weeks, significantly reduced total-C, LDL-C, apo B, and TG. (Pooled results are provided in Table 9.)
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| Dose | N | TC | LDL-C | Apo B | TG | HDL-C | Non-HDL-C/ HDL-C |
| Placebo | 21 | 4 | 4 | 3 | 10 | -3 | 7 |
| 10 | 22 | -29 | -39 | -32 | -19 | 6 | -34 |
| 20 | 20 | -33 | -43 | -35 | -26 | 9 | -41 |
| 40 | 21 | -37 | -50 | -42 | -29 | 6 | -45 |
| 80 | 23 | -45 | -60 | -50 | -37 | 5 | -53 |
In patients with Fredrickson Types IIa and IIb hyperlipoproteinemia pooled from 24 controlled trials, the median (25 th and 75 th percentile) percent changes from baseline in HDL-C for atorvastatin 10 mg, 20 mg, 40 mg, and 80 mg were 6.4 (-1.4, 14), 8.7 (0, 17), 7.8 (0, 16), and 5.1 (-2.7, 15), respectively. Additionally, analysis of the pooled data demonstrated consistent and significant decreases in total-C, LDL-C, TG, total-C/HDL-C, and LDL-C/HDL-C.
In three multicenter, double-blind studies in patients with hyperlipidemia, atorvastatin was compared to other statins. After randomization, patients were treated for 16 weeks with either atorvastatin 10 mg per day or a fixed dose of the comparative agent (Table 10).
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| Treatment (Daily Dose) | N | Total-C | LDL-C | Apo B | TG | HDL-C | Non-HDL-C/ HDL-C |
| Study 1 | |||||||
| Atorvastatin 10 mg | 707 | -27 * | -36 * | -28 * | -17 * | +7 | -37 * |
| Lovastatin 20 mg | 191 | -19 | -27 | -20 | -6 | +7 | -28 |
| 95% CI for Diff † | -9.2, -6.5 | -10.7, -7.1 | -10.0, -6.5 | -15.2, -7.1 | -1.7, 2.0 | -11.1, -7.1 | |
| Study 2 | |||||||
| Atorvastatin 10 mg | 222 | -25 ‡ | -35 ‡ | -27 ‡ | -17 ‡ | +6 | -36 ‡ |
| Pravastatin 20 mg | 77 | -17 | -23 | -17 | -9 | +8 | -28 |
| 95% CI for Diff † | -10.8, -6.1 | -14.5, -8.2 | -13.4, -7.4 | -14.1, -0.7 | -4.9, 1.6 | -11.5, -4.1 | |
| Study 3 | |||||||
| Atorvastatin 10 mg | 132 | -29 § | -37 § | -34 § | -23 § | +7 | -39 § |
| Simvastatin 10 mg | 45 | -24 | -30 | -30 | -15 | +7 | -33 |
| 95% CI for Diff † | -8.7, -2.7 | -10.1, -2.6 | -8.0, -1.1 | -15.1, -0.7 | -4.3, 3.9 | -9.6, -1.9 | |
The impact on clinical outcomes of the differences in lipid-altering effects between treatments shown in Table 10 is not known. Table 10 does not contain data comparing the effects of atorvastatin 10 mg and higher doses of lovastatin, pravastatin, and simvastatin. The drugs compared in the studies summarized in the table are not necessarily interchangeable.
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