Use of Atorvastatin in Lipid Disorders and Cardiovascular Disease in Chinese Patients

Abstract

Objective:Statins are still underused for the prevention of cardiovascular disease (CVD) in China. Hence, we conducted a systemic review on the pharmacology, clinical efficacy, and adverse events of atorvastatin, as well as on patient adherence.Data Sources:We conducted a systemic search in PubMed with the following keywords: “atorvastatin” (Supplementary concept) or “atorvastatin” (All field) and (“China” [AD] or “China” [all field] or “Chinese” [All field]).Study Selection:Clinical or basic research articles on atorvastatin were included.Results:Atorvastatin is a reversible and competitive inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, decreasing the de novo cholesterol synthesis. The pharmacokinetics of atorvastatin among Chinese is similar to those in Caucasians, and several gene polymorphisms have proved to be associated with the metabolism of atorvastatin in the Chinese population. Several international multiple-center randomized control trials have demonstrated the benefit of atorvastatin for primary and secondary prevention of CVD. None of them, however, included the Chinese, and current evidence in the population is still inadequate, due to the small sample size, low study quality, short study duration, and the use of surrogate endpoints instead of clinical endpoints. The overall incidence of adverse events observed with atorvastatin did not increase in the 10–80 mg dose range, and was similar to that observed with placebo and in patients treated with other statins, which makes atorvastatin well-tolerated in the Chinese population. Moreover, high patient adherence was observed in clinical studies.Conclusions:Based on the current available evidence, there is no significant difference between Chinese and non-Chinese population in term of pharmacology and clinical efficacy/safety. High-quality evidence is still needed to support the use of atorvastatin in high-risk Chinese population.

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“…Another study by Barakat et al, 18 concludes that different dosages of statins did not significantly affect the serum creatinine and glomerular filtration rate after 2 years. Results of the present investigation also correlate with the previous study of Ye et al, 19 reporting that the overall incidence of treatment-associated adverse events observed with atorvastatin did not increase in the10 -80 mg dose range. Therefore according to this observational study, there is no significant difference in adverse outcome as far as low dose or high dose of atorvastatin usage is concerned in post coronary or cerebrovascular event therapy.…”

Safety of atorvastatin in Asian patients within clinical trials

“…Although a growing body of evidence demonstrates the efficacy and safety of atorvastatin in Asian populations of both East Asian31, 32, 33, 34, 35, 36, 37 and South Asian34, 38, 39, 40, 41, 42, 43, 44 origin, many of these previous studies evaluated the safety profile of atorvastatin doses up to 20‐mg over relatively short study durations (6–12 weeks) 31, 33, 35, 36, 41, 42, 43. This current analysis has extended these observations to atorvastatin doses up to 80‐mg and provides strong evidence to support the safety of conventional doses of atorvastatin (10–40‐mg daily) in Asian patients over the short‐ and longer‐term (up to 4.9 years) for intensive lipid lowering.…”

Atorvastatin promotes AMPK signaling to protect against high fat diet‑induced non‑alcoholic fatty liver in golden hamsters

“…Atorvastatin (Ato), a lipid-decreasing agent, is the most commonly prescribed statin drug worldwide (14), and is used for the treatment of hypercholesterolemia or mixed dyslipidemia. Mechanistically, Ato exerts its protective roles by competitively inhibiting 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase, which is known to suppress the mevalonate pathway and subsequently de novo hepatic cholesterol (CHO) synthesis (15).…”