NDRI.com

High Dose Atorvastatin (Lipitor) for Patients With a History of Heart Failure

Several types of medicine are used to treat high cholesterol levels. Your doctor will decide which type of medicine is right for you. He or she may prescribe more than 1 of these drugs at a time because combinations of these medicines can be more effective.Lowering your "bad" cholesterol (also called LDL, or low-density lipoprotein) can reduce your risk of having a heart attack or stroke. A number of lifestyle changes can help you improve your cholesterol level (see the box below). However, if these lifestyle changes don't help after about 6 months to 1 year, your doctor may suggest medicine to lower your cholesterol.

Atorvastatin is used for the treatment of high cholesterol and triglyceride levels. High blood cholesterol is first treated with exercise, weight loss, and a diet low in cholesterol and saturated fats. When these measures fail to achieve enough cholesterol-lowering, medications such as atorvastatin may be added. Using this medicine may help prevent medical problems caused by such substances clogging the blood vessels. This medicine may also be used to prevent certain types of heart problems in adults with risk factors for heart problems.

The effectiveness of atorvastatin in lowering cholesterol is dose related, meaning that higher doses reduce cholesterol more. Blood cholesterol determinations are performed at regular intervals during treatment so that adjustments in doses can be made. Atorvastatin (10-40mg)is prescribed once daily.With 2005 sales of US$12.2 billion under the brand name Lipitor, it is the largest selling drug in the world.

For people with coronary artery disease, treatment with high doses of Lipitor (generic name, atorvastatin) may reduce their odds of having to be hospitalized for heart failure, according to a new report. However, this benefit is largely confined to individuals with a history of heart failure.

The findings come from an analysis of data from the Treating to New Targets (TNT) study, which has already shown that patients treated with high-dose atorvastatin had 22 percent fewer 'cardiac events' than those given low-dose atorvastatin. "The focus of our analysis was to determine if high-dose atorvastatin had any effect on hospitalizations for heart failure," Dr. David D. Waters, from San Francisco General Hospital, explained to Reuters Health.

As Waters and his colleagues note in their report in the American Heart Association's journal Circulation, statin drugs like Lipitor have effects that suggest they might be useful for treating heart failure, but there's also a possibility that they may actually worsen the condition.

The team's analysis involved 10,000 patients with heart disease who were assigned to take Lipitor at a dose of 80 milligrams or 10 milligrams per day and were followed for an average of nearly 5 years. None of them had advanced heart failure, but about 8 percent of them had a history of heart failure.

The hospitalization rate for heart failure in the high-dose group was 2.4 percent compared with 3.3 percent in the low-dose group, which translates to a reduction in risk of 26 percent.

Most of the benefit was seen in the patients with a history of heart failure. In this group, high-dose and low-dose atorvastatin were associated with hospitalization rates of 10.6 percent and 17.3 percent, respectively.

"Atorvastatin and other statins are not specifically approved to treat heart failure, but our findings suggest that if you have a patient who is taking atorvastatin for another reason -- such as high cholesterol or heart disease -- it might be smart to use the higher dose," Waters commented.