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Am Fam Physician. 2004;70(5):950

When atorvastatin is taken at a dosage of 40 mg per day, it has been demonstrated to normalize triglyceride-rich lipoprotein and low-density lipoprotein (LDL) levels in fasting and postprandial patients with coronary heart disease (CHD). Fasting is not necessary for accurate detection of lipid abnormalities if the various cholesterol fractions are measured directly. Comparing the effects of atorvastatin with those of other statins would be useful in choosing appropriate lipid-lowering therapy.

Schaefer and associates studied patients with documented CHD who had elevated serum LDL cholesterol levels while not taking lipid-lowering medications. All patients were educated about appropriate nutrition and randomized to receive atorvastatin or one of four other statins (fluvastatin, pravastatin, lovastatin, or simvastatin), starting at a dosage of 20 mg per day and increasing dosages at four-week intervals up to a maximum dosage.

A second 12-week statin period was then imposed, with those taking atorvastatin randomized to one of the other four statins and those who had initially received one of the other four statins receiving atorvastatin. The same dosage adjustment was used. Fasting and postprandial serum sampling after a high-fat meal occurred at four-week intervals. An equal number of patients free of CHD who matched the treatment group in age and gender also were studied at similar intervals.

Atorvastatin was significantly more effective than fluvastatin in reducing all cholesterol parameters at all doses. Compared with lovastatin, atorvastatin was significantly better at reducing all cholesterol parameters at the 80-mg dosage, and reduced LDL cholesterol and triglyceride levels more significantly at all dosages. Atorvastatin was significantly more effective than pravastatin in lowering most cholesterol parameters at all dosages. Atorvastatin was significantly more effective than simvastatin in lowering most cholesterol parameters at 20-mg and 80-mg daily dosages. The 40-mg dosage of atorvastatin also significantly increased large high-density lipoprotein particles more than the other statins, except simvastatin. Patients who were hyporesponsive or hyperresponsive to one statin maintained that level of responsiveness when exposed to a different statin. These results correlated well using fasting and postprandial direct measurements

The authors conclude that atorvastatin taken at dosages of 20 to 80 mg daily effectively alters all cholesterol and triglyceride parameters in the fasting and the post-prandial state in persons with CHD, to a level comparable with a control group. The effectiveness of other statins at every dosage for all parameters was approximately 33 percent for fluvastatin, 50 percent for pravastatin, 60 percent for lovastatin, and 85 percent for simvastatin.

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