Atorvastatin and statins: what they are used for and what to know

Statins are a group of prescription medicines that lower cholesterol. Their technical name is HMG-CoA reductase inhibitors. Atorvastatin (original brand Lipitor) and rosuvastatin (brand Crestor) are among the most widely used; others include simvastatin, pravastatin, lovastatin and pitavastatin. Statins are not controlled substances.

How they work. According to MedlinePlus, they block an enzyme the liver needs to make cholesterol. With less cholesterol made, the liver pulls more LDL cholesterol out of the blood. That is why they lower LDL and, with it, the risk of a heart attack or stroke. They are used along with healthy eating, physical activity and, when needed, weight loss; they do not replace them.

According to the FDA label, atorvastatin is approved to:

The American College of Cardiology and American Heart Association (ACC/AHA) guideline recommends statins as the first-choice medicine for lowering cardiovascular risk. In general, they are considered for:

• People who have already had a heart attack, a stroke or other artery disease.
• People with very high LDL (190 mg/dL or higher).
• Adults with diabetes aged 40 to 75.
• Adults aged 40 to 75 whose 10-year heart disease risk the doctor judges high enough, based on age, blood pressure, cholesterol, diabetes and smoking.

These are general criteria: the decision is individual. The doctor reviews your history, your lipid panel and your risk, and talks through the benefits and possible side effects with you before deciding.

10, 20, 40 and 80 mg tablets. Per the FDA label, the adult dose ranges from 10 to 80 mg once a day, and it can be taken at any time of day, with or without food. The starting dose and adjustments depend on your LDL level, your risk and the other medicines you take.

Rosuvastatin. It comes in tablets from 5 to 40 mg once a day. The label advises considering lower starting doses in people of Asian ancestry and adjusting the dose in severe kidney problems.

Consistency. According to MedlinePlus, you keep taking a statin even when you feel well, because high cholesterol causes no symptoms. If you miss a dose, take it when you remember unless it is almost time for the next one; do not double up.

The doctor decides the dose. Do not change it or stop the medicine on your own.

Many people tolerate statins well. According to the FDA label and MedlinePlus, the most common side effects include:

Muscle aches are the best-known complaint with statins. Most are mild and do not damage the muscle, but the label includes a warning about myopathy (muscle damage) and, rarely, rhabdomyolysis, a serious breakdown of muscle that can affect the kidneys.

What to do. Tell the doctor about muscle pain, tenderness or weakness that a recent workout does not explain. She can review your labs, adjust the dose, switch statins or decide on another approach. Do not stop the medicine on your own if the discomfort is mild.

Get urgent care if the muscle pain is severe, or comes with fever, feeling unwell or brown or dark red urine. If it is severe, call 911 or go to the emergency room.

Higher risk. The label notes a higher risk of muscle problems with older age, kidney problems, untreated low thyroid (hypothyroidism) and high doses, and when combined with certain medicines.

Liver. Statins can raise liver enzymes in some people. Per the label, liver enzymes are checked before starting and afterward if symptoms appear. The atorvastatin label lists acute liver failure and decompensated cirrhosis as contraindications. Having fatty liver or slightly elevated enzymes does not by itself rule out a statin; the doctor evaluates your case.

Blood sugar. The label says increases in A1C and fasting blood sugar have been reported with statins. Experts generally find the heart benefit outweighs that risk in most people at cardiovascular risk, and people with prediabetes or diabetes continue to be monitored with lab tests.

Memory. The FDA has reported cases of mild, reversible confusion or memory loss with statins; it is uncommon. If you notice it, tell the doctor.

Before starting, tell the doctor and the pharmacist everything you take, including supplements and natural products. Per the FDA label and MedlinePlus:

Pregnancy. In 2021 the FDA removed the blanket contraindication for statins in pregnancy, but it recommends that most pregnant patients stop taking them, because chronic high cholesterol changes little over a few months off treatment. If you are pregnant, think you may be or are planning a pregnancy, talk with the doctor; do not stop or change your medicines without guidance unless she tells you to.

Breastfeeding. Per the label, breastfeeding is not recommended while taking atorvastatin. If you breastfeed, tell the doctor.

Statin treatment comes with blood tests. They usually include:

• Lipid panel (total cholesterol, LDL, HDL and triglycerides) before starting and about 4 to 12 weeks later to see how your body responds; then at intervals that fit your case.
• Liver enzymes before starting and if symptoms appear.
• A1C or glucose, especially with diabetes, prediabetes or obesity.
• Kidney and thyroid function if there are muscle symptoms or risk factors.

The doctor can give you a lab order and go over the results with you. To make sense of your numbers, read how to understand your lab results.

A statin works best alongside healthy habits, not instead of them. According to the ACC/AHA guideline and MedlinePlus, these help: eating more vegetables, fruit, whole grains, fish and healthy fats and less saturated and trans fat; regular physical activity; reaching a healthy weight; quitting smoking; and controlling blood pressure and blood sugar. See the full approach under high cholesterol.