Coronary heart disease atorvastatin

Mikhailidis DP, Wierzbicki AS. HDL-cholesterol and the treatment of coronary heart disease contrasting effects of atorvastatin and simvastatin. Curr Med Res Opin 2000 16(2) 139-46. 

Seljeflot I, Tonstad S, Hjermann I, Arnesen H, Reduced expression of endothelial cell markers after I year treatment with simvastatin and atorvastatin in patients with coronary heart disease, Atherosclerosis 2002 162 179-1 85,... 

AECAPS/TexCAPS = Air ForceAexas Coronary Atherosclerosis Prevention Study (Downs et ah, 1998) Helsinki = The Helsinki Heart Study (Frick et al., 1 987) LRC-CPPT = The Lipid Research Clinics Coronary Primary Prevention Trial (insull et al., 1984) Oslo = The Oslo Study (Hjermann et ah, 1988) WOSCOPS = The West of Scotland Coronary Prevention Study (Shepherd et al., 1995) ALLHAT = Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial approximately 13-15% of patients had a history of coronary heart disease (CHD) events are CHD events only WHI = Women s Health initiative RRR = relative risk reduction ARR = absolute risk reduction NNT = number needed to treat NA = not available CEE = conjugated equine estrogen MPA = medroxyprogesterone acetate CARDS = Collaborative Atorvastatin Diabetes Study (presented at the 2004 American Diabetes Association meeting). 

Multiple well-controlled clinical trials have documented the efhcacy and safety of simvastatin, pravastatin, lovastatin, and atorvastatin in reducing fatal and nonfatal coronary heart disease (CHD) events, strokes, and total mortality. Rates of adverse events in statin trials were the same in the placebo groups and in the groups receiving the drug. This was trae with regard to noncardiac illness and the two laboratory tests, hepatic transaminases and creatine kinase (CK), that are commonly monitored in patients taking statins. 

Lovastatin (Mevacor ) (3), simvastatin (Zocor ) (15), pravastatin (Pravachol ) (19), atorvastatin (Lipitor ) (20), cerivastatin (Baycol , withdrawn on August 1, 2003) (21), and fluvastatin (Lescol ) (22) were introduced to lower total cholesterol levels, and especially LDL-cholesterol levels to prevent coronary heart disease. These HMG-CoA inhibitors inhibit de novo synthesis of cholesterol in the liver. The rate-limiting enzyme in cholesterol synthesis is HMG-CoA reductase, which catalyzes the conversion of HMG-CoA to mevalonate. The resulting decrease in hepatic cholesterol synthesis leads to increased synthesis of... 

Knopp RH, d Emden M, Smilde JG, Pocock SJ (2006) Efficacy and safety of atorvastatin in the prevention of cardiovascular end points in subjects with type 2 diabetes the Atorvastatin Study for Prevention of Coronary Heart Disease Endpoints in non-insuUn-dependent diabetes meUitus (ASPEN), Diabetes Care 29 1478-1485. 

Placebo-controlled studies Atorvastatin 10 mg/day has been compared with placebo in 2838 patients with type 2 diabetes melli-tus and no history of coronary heart disease over 3.9 years [41 "]. The percentages of patients with treatment-associated adverse events, serious adverse events, and who withdrew because of adverse events respectively were 23% versus 25%, 1.1% versus 1.1%, and 2.9% versus 3.4%. The most common treatment-associated adverse events were gastrointestinal (8.9% versus 10%) and there was myalgia in (5.0% and 6.0%). 

Endocrine In 77 men with coronary heart disease atorvastatin 40-80 mg/day and for 12 weeks had no significant effects on serum total testosterone, free testosterone, sex hormone-binding globulin, luteinizing hormone, or follicle stimulating hormone compared with 83 men who took 10-20 mg/day [42 "]. 

Cardiovascular As was reported in SEDA-32 (p. 817), ILLUMINATE, an outcome study that recruited around 15 000 statin-eligible patients with coronary heart disease or type 2 diabetes mellitus was terminated after a median follow-up of only 550 days, because of a small but significant increase in major cardiovascular events in those taking torcetrapib - - atorvastatin compared with those taking atorvastatin alone (49 versus 35 cardiovascular deaths) [69. This occurred despite a 72% increase in HDL cholesterol and a 25% reduction in LDL cholesterol compared with the statin alone. This was almost certainly correctly attributed to activation of the renin-angiotensin-aldosterone system, resulting in increments in blood pressure and aldosterone and reduced potassium. 

Tershakovec AM. Efficacy and safety of ezetimibe added on to atorvastatin (40 mg) compared with uptitration of atorvastatin (to 80 mg) in hypercholesterolemic patients at high risk of coronary heart disease. Am J Cardiol 2008 102(11) 1495-501. 

Atorvastatin is one of a widely prescribed class of drugs called statins, which reduce a person s risk of coronary heart disease by lowering the level of cholesterol in their blood. Taken together, the statins—atorvastatin (Lipitor), simvastatin (Zocor), rosuvastatin (Crestor), pravastatin (Pravachol), lovastatin (Mevacor), and several others—are the most widely prescribed drugs in the world, with an estimated 14.6 billion in annual sales. 

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