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The Lowdown on Lipitor: What You Need To Know

Medically reviewed on May 4, 2017 by L. Anderson, PharmD.

The World's Top Selling Drugs

Lipitor (atorvastin) was once the world's top selling drug. When it hit the market in 1997, it was the fifth approved statin, a class of blockbuster drugs that revolutionized the treatment of high cholesterol. Within just a few years, Lipitor was the top selling statin, generating sales for Pfizer of over $120 billion in a 14-year run. Lipitor by-passed other statins on the market, like Mevacor (lovastatin), Lescol (fluvastatin), and Pravachol (pravastatin), by lowering LDL, or "bad" cholesterol, at lower doses.

Now that millions more are taking the more affordable generic statins since Lipitor's patent loss in 2011, it's time to refresh our memory of this life-saving class of drugs many people depend upon to help with cholesterol levels.

Statins: How Do They Work?

Lipitor (atorvastatin) is in the drug class of HMG-CoA reductase inhibitors, but it is more commonly referred to as a "statin". Statins are a group of drugs which lower levels of cholesterol and triglycerides in the blood. Statins may also reduce the risk of heart attack or stroke in those who have risk factors like heart disease or type 2 diabetes. Other common statins include:

Statins works by blocking an enzyme in your body used to make cholesterol. These drugs work best when they are combined with a healthy diet low in saturated fat and salt, high in fruits and vegetables, plus 40 minutes of moderate-intensity exercise 3 to 4 times per week.

Is Cholesterol Still An Important Target for Heart Health?

Absolutely. Studies show that high cholesterol contributes to plaque building in the arteries that can lead to a heart attack or stroke. Although you may have heard about recently updated heart association guidelines, blood tests that measure lipids such as LDL ("bad") and HDL ("good") cholesterol are still needed. That has not changed.

What has changed is that your doctor may look more at your overall risk for heart disease or a heart attack in the future rather than focus solely on your cholesterol numbers to determine if you need drug treatment. Risk factors, like diet, smoking status, blood pressure, weight, family history, and other factors also come into play.

Generics Can Lower Cholesterol and Your Overall Healthcare Bill

Most statins like Lipitor are now available as cost-saving generics.

Generic statins like atorvastatin, pravastatin, lovastatin, or simvastatin are available at a lower cost than their brand-name alternatives and may lower your cholesterol equally well. Talk to your insurance company to see which cholesterol treatments are the most affordable based on their list of covered drugs known as a Formulary.

Also, have a frank discussion with your doctor and pharmacist to keep your treatment costs within reach. If you can't afford your statin, you're much less likely to fill your prescription.

Need-To-Know: Statin Advice

The latest guidelines for statin side effects suggest:

  • Memory loss and confusion have been reported with statin use.
  • Routine liver enzyme lab tests are no longer necessary, but should be checked when treatment is started.
  • Blood sugar levels should be checked regularly.
  • Statins can increase the risk of muscle pain and muscle damage (myopathy).
  • Drugs interactions can be frequent and a drug interaction screen should always be checked.
Most people can continue taking their statins safely; always discuss your options with your doctor.

Statins May Up the Risk for Type 2 Diabetes

Statins have been linked with an increased risk for types 2 diabetes in several studies. In fact, a large study out of Finland found that statins were associated with between a 28 to 44 percent higher risk of developing type 2 diabetes. Statins appear to do this by increasing a person's insulin resistance, and by impairing the ability of the pancreas to secrete insulin. In the study, the higher the dose of the statin, the more closely associated it was with diabetes development. So what does this mean? You should discuss with your doctor and weigh the benefit compared to harms of statin treatment if you are at risk for diabetes, especially if you have blood sugar levels at the higher end and are at risk for prediabetes or diabetes already.

The Concern Over Muscle Injury

Side effects and drug interactions are possible with all statins. For example, some statins are broken down (metabolized) through some of the same pathways that many other drugs follow.

Competition for these pathways can increase the amount of statin in your blood and the risk for myopathy, a rare muscle injury. Myopathy causes muscle pain, tenderness or weakness, and can be serious, rarely resulting in a condition called rhabdomyolysis.

Contact your doctor about any unusual muscle pain or weakness, a general tired feeling, or fever. Always have your pharmacist run a drug interaction screen each time you start (or even stop) any medication.

Statin Dosing

One of the benefits of statins is that they can be taken orally as a tablet, usually only once a day. Studies have shown that if you only have to take a medication once daily, you're much more likely to stick with it over time.

Most patients start taking statins at low doses. Your doctor may decide to increase your dose in a few weeks, if needed. If you have active liver disease or unexplained elevated liver enzymes tests (LFTs), statin treatment should usually not be started.

In Light of Recent Concerns, Should I Keep Taking My Statin?

The information on risks for type 2 diabetes, memory lapses, muscle injury, and possible drug interactions should not scare people away from the heart disease-lowering statins. These events are rare and, in general, reversible once detected. Statins have been shown to lower the risk for heart attack and stroke events, and the benefit of statins in preventing heart disease has been clearly established. They are a major breakthrough in the prevention of cardiovascular disease.

Working in conjunction with your doctor, you can determine your overall cardiac risk, and consider lifestyle changes that are needed, such as diet and exercise. Plus, have a frank discussion about the value of statins, or other cholesterol-lowering agents, as part of your risk reduction plan. It's always important to review your family history of heart disease, too.

Statin Use: Do You Fall Within These Parameters?

The latest November 2016 USPSTF statin recommendations state the following:

  • Initiate use of low- to moderate-dose statins in adults aged 40 to 75 years without a history of heart disease who have 1 or more heart risk factors, like high lipids levels, diabetes, hypertension, or smoking
  • And a calculated 10-year cardiovascular disease event risk of 10% or greater.
  • The USPSTF also recommends that clinicians selectively offer low- to moderate-dose statins to adults aged 40 to 75 years without a history of CVD who have 1 or more CVD risk factors and a calculated 10-year CVD event risk of 7.5% to 10%. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating statin use in adults 76 years and older. Initiation of statin therapy is an individual decision and patients should always discuss their particular risk factors with their doctor.

What Else Can I Do to Lower Cholesterol?

Sometimes it's easy to blame ourselves when our calculated 10-year heart risk or lipid numbers are high, especially when we've been sticking to diet and exercise. But family history and genetics can play a large part in elevated cholesterol, too, and we can't always control that. It may be that a cholesterol-lowering medication, like a statin - even at a low dose - may be beneficial to lower your risk. Lower doses, if possible, may lower your risk of side effects, too.

Statins are recommended as first-line treatments, but other options, like cholesterol absorption inhibitors such as ezetimibe (Zetia), bile acid binding resins (used less today because they also lower HDL - good cholesterol), niacin, and fibrates like gemfibrozil (Lopid) or fenofibrate (Tricor) are other options. Some dietary supplements, such as fish oils or flaxseed oil, may be helpful, too.

Finished: The Lowdown on Lipitor: What You Need To Know

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Sources

  • Final Update Summary: Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication. U.S. Preventive Services Task Force. November 2016. Accessed May 4, 2017 at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/statin-use-in-adults-preventive-medication1?ds=1&s=cholesterol
  • Statin Use for the Primary Prevention of Cardiovascular Disease in Adults US Preventive Services Task Force Recommendation Statement. The JAMA Network. November 15, 2016. Accessed May 4, 2017 at http://jamanetwork.com/journals/jama/fullarticle/2584058
  • American Heart Association. AHA, ACC reaffirm new cardiovascular prevention guidelines, risk calculator. November 18, 2013. Accessed May 4, 2017 at http://news.heart.org/aha-acc-reaffirm-new-cardiovascular-prevention-guidelines-risk-calculator/
  • U.S. Food and Drug Administration (FDA). Cholesterol-lowering drugs get labeling changes. Accessed May 4, 2017 at http://www.fda.gov/Drugs/ResourcesForYou/SpecialFeatures/ucm290856.htm
  • American Heart Association. Drug Therapy for Cholesterol. Updated May 15, 2014. Accessed May 4, 2017 at http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Drug-Therapy-for-Cholesterol_UCM_305632_Article.jsp
  • Drugs.com. Statins Linked to Raised Risk of Type 2 Diabetes. Accessed May 4, 2017 at https://www.drugs.com/news/statins-linked-raised-risk-type-2-diabetes-55891.html
  • Drugs.com. First Generic Lipitor Approved. Accessed May 4, 2017 at https://www.drugs.com/news/first-lipitor-approved-35138.html
  • Drugs.com. Mayo Clinic. Metabolic syndrome. Accessed May 4, 2017 at https://www.drugs.com/mcd/metabolic-syndrome
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