Skip to main content
SpringerLink
Log in

Management of Dyslipidaemias

The Potential Role of Atorvastatin

  • Drugs in Disease Management
  • Published:
Disease Management and Health Outcomes

Summary

Dyslipidaemias, particularly elevated serum low density lipoprotein (LDL) cholesterol levels and low levels of high density lipoprotein (HDL) cholesterol, are major risk factors for the development of atherosclerosis and subsequent coronary heart disease (CHD). It is well accepted that reducing total cholesterol and LDL-cholesterol levels, regardless of the intervention used, can significantly reduce the risk of CHD morbidity and mortality.

Once a dyslipidaemia has been identified, secondary causes should be identified and treated, where possible, and other risk factors for CHD managed. Nonpharmacological interventions (including diet and lifestyle modifications) are the first step in the management of all patients with dyslipidaemia. If target serum lipid levels are not achieved after 3 to 6 months of nonpharmacological intervention (or <3 months in those with CHD), drug therapy may be considered.

The main drug classes available for the treatment of dyslipidaemia are the 3-hydroxy-3-methylglutaryl-coenzyme-A (HMG-CoA) reductase inhibitors (‘statins’), fibric acid derivatives, bile acid séquestrants and nicotinic acid. Probucol may be used in selected patients. Treatment choices are influenced by the presence of established CHD or risk factors for CHD and the type and severity of dyslipidaemia.

Atorvastatin has greater LDL-cholesterol—lowering activity than other members of its class; it also has greater triglyceride-lowering properties. Atorvastatin appears to have a similar tolerability profile to other HMG-CoA reductase inhibitors; however, longer term tolerability data are required. Available evidence from modelling studies or economic assessments of clinical trial data suggests that atorvastatin is more cost-effective than other HMG-CoA reductase inhibitors in terms of cost per unit of cholesterol lowering achieved; confirmatory data are required.

Thus, on the basis of the available evidence, atorvastatin represents a first-line treatment option for patients with diet-resistant primary hypercholesterolaemia. Whether this agent has beneficial effects on coronary morbidity, mortality and/or total mortality, as confirmed for some other HMG-CoA reductase inhibitors, is currently being determined. The marked LDL-cholesterol—lowering activity of atorvastatin may make this drug particularly suitable for patients with heterozygous familial hypercholesterolaemia; it may be used alone or as an adjunct to other lipid-lowering treatments in patients with homozygous familial hypercholesterolaemia. Atorvastatin also appears to be an appropriate treatment for patients with combined hyperlipidaemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lea AP, McTavish D. Atorvastatin: a review of its pharmacology and therapeutic potential in the management of hyper-lipidaemias. Drugs 1997 May; 53: 828–47.

    Google Scholar 

  2. Betteridge DJ, Dodson PM, Durrington PN, et al. Management of hyperlipidaemia: guidelines of the British Hyperlipidae-mia Association. Postgrad Med J 1993 May; 69: 359–69.

    Google Scholar 

  3. Grundy SM, Bilheimer D, Chait A, et al. Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). JAMA 1993 Jun 16; 269: 3015–23.

    Article  Google Scholar 

  4. Brown MS, Goldstein JL. Disorders of intermediary metabolism. In: Wilson JD, Braunwald E, Isselbacher KJ, et al., editors. Harrison’s principles of internal medicine. 12th ed. v. 2: McGraw-Hill, 1991: 1814–25.

  5. Oki JC. Dyslipidemias in patients with diabetes mellitus: classification and risks and benefits of therapy. Pharmacotherapy 1995; 15 (3): 317–37.

    PubMed  CAS  Google Scholar 

  6. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. National Cholesterol Education Program. Second report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). III. Drug Treatment. Circulation 1994 Mar; 89: 1405–19, 1432–45.

    Google Scholar 

  7. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. National Cholesterol Education Program. Second report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II): IV. Special Issues. Circulation 1994; 89: 1420–45.

    Google Scholar 

  8. Betteridge DJ. Lipids and atherogenesis in diabetes mellitus. Atherosclerosis 1996 Jul; 124 Suppl.: S43–47.

    Article  PubMed  CAS  Google Scholar 

  9. Pyörälä K, De Backer G, Graham I, et al. Prevention of coronary heart disease in clinical practice: recommendations of the Task Force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension. Atherosclerosis 1994 Oct; 110: 121–61.

    Google Scholar 

  10. Tenkanen L, Pietilä K, Manninen V, et al. The triglycéride issue revisited. Findings from the Helsinki Heart Study. Arch Intern Med 1994 Dec 12–26; 154: 2714–20.

    Article  PubMed  CAS  Google Scholar 

  11. Brown WV. Hypercholesterolaemia in the United States: how far have we come? Am J Med 1997 Feb 17; 102 Suppl. 2A: 3–6.

    Article  PubMed  CAS  Google Scholar 

  12. Stampfer MJ, Krauss RM, Ma J, et al. A prospective study of triglycéride level, low-density lipoprotein particle diameter, and risk of myocardial infarction. JAMA 1996 Sep 18; 276 (11): 882–8.

    Article  PubMed  CAS  Google Scholar 

  13. Criqui MH, Heiss G, Cohn K, et al. Plasma triglycéride level and mortality from coronary heart disease. N Engl J Med 1993 Apr 29; 328: 1220–5.

    Article  PubMed  CAS  Google Scholar 

  14. Austin MA. Plasma triglycéride and coronary heart disease. Arterioscler Thromb Vasc Biol 1991; 11: 2–14.

    Article  CAS  Google Scholar 

  15. Study Group of the European Atherosclerosis Society. The recognition and management of hyperlipidaemia in adults: a policy statement of the European Atherosclerosis Society. Eur Heart J 1988; 9: 571–600.

    Google Scholar 

  16. Assmann G, Cullen P, Heinrich J, et al. Hemostatic variables in the prediction of coronary risk: results of the 8 year follow-up of healthy men in the Münster Heart Study (PROCAM). Isr J Med Sci 1996; 32: 364–70.

    PubMed  CAS  Google Scholar 

  17. Shepherd J. Profiling risk and new therapeutic interventions: looking ahead. Am J Med 1998; 104 (2A): 19S–22S.

    Article  PubMed  CAS  Google Scholar 

  18. Anderson KM, Wilson WF, Odell PM, et al. An updated coronary risk profile: a statement for health professionals. Circulation 1991; 83 (1): 356–62.

    Article  PubMed  CAS  Google Scholar 

  19. Castelli WP. The triglycéride issue revisited: a view from Framingham. Am Heart J 1986; 112 (2): 432–7.

    Article  PubMed  CAS  Google Scholar 

  20. Grundy SM. Consensus statement: role of therapy with “statins” in patients with hypertriglyceridaemia. Am J Cardiol 1998; 81 (4A): 1B–6B.

    Article  PubMed  CAS  Google Scholar 

  21. Eaton CB, Feldman HA, Assaf AR, et al. Prevalence of hypertension, dyslipidemia, and dyslipidemic hypertension. J Fam Pract 1994 Jan; 38: 17–23.

    Google Scholar 

  22. Wilson PW. The epidemiology of hypercholesterolemia. A global perspective. Am J Med 1989 Oct 16; 87: 5S–13S.

    Article  PubMed  CAS  Google Scholar 

  23. Thelle DS. Epidemiology of hypercholesterolemia and European management guidelines. Cardiology 1990; 77 Suppl. 4:2–7.

    Article  PubMed  Google Scholar 

  24. Sempos CT, Cleeman JI, Carroll MD, et al. Prevalence of high blood cholesterol among US adults: an update based on guidelines from the second report of the National Cholesterol Education Program Adult Treatment Panel [see comments]. JAMA 1993 Jun 16; 269: 3009–14.

    Article  PubMed  CAS  Google Scholar 

  25. Allen JK, Young DR, Blumenthal RS, et al. Prevalence of hypercholesterolemia among siblings of persons with premature coronary heart disease: application of the Second Adult Treatment Panel Guidelines. Arch Intern Med 1996 Aug 12–26; 156: 1654–60.

    Article  PubMed  CAS  Google Scholar 

  26. Schucker B, Wittes JT, Santanello NC, et al. Change in cholesterol awareness and action: results from national physician and public surveys. Arch Intern Med 1991; 151: 666–73.

    Article  PubMed  CAS  Google Scholar 

  27. LaRosa JC, Hunninghake D, Bush D, et al. The cholesterol facts. A summary of the evidence relating dietary fats, serum cholesterol, and coronary heart disease: a joint statement by the American Heart Association and the National Heart, Lung, and Blood Institute. The Task Force on Cholesterol Issues, American Heart Association. Circulation 1990; 81: 1721–33.

    Article  PubMed  CAS  Google Scholar 

  28. Brown BG, Zhao X-Q, Bardsley J, et al. Secondary prevention of heart disease amongst patients with lipid abnormalities: practice and trends in the United States. J Intern Med 1997 Apr; 241: 283–94.

    Google Scholar 

  29. Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study Group (4S). Lancet 1994; 344: 1383–9.

    Google Scholar 

  30. Multiple Risk Factor Intervention Trial Research Group. Multiple risk factor intervention trial: risk factor changes and mortality results. JAMA 1982; 148 (12): 1465–77.

    Google Scholar 

  31. The Lipid Research Clinics Coronary Primary Prevention Trial results. II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA 1984; 251: 365–74.

    Article  Google Scholar 

  32. The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease. JAMA 1984; 251: 351–64.

    Article  Google Scholar 

  33. Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996; 335: 1001–9.

    Article  PubMed  CAS  Google Scholar 

  34. Frick MH, Elo O, Haapa K, et al. Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. N Engl J Med 1987; 317 (20): 1237–45.

    Article  PubMed  CAS  Google Scholar 

  35. Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995; 333 (20): 1301–7.

    Article  PubMed  CAS  Google Scholar 

  36. West of Scotland Coronary Prevention Group. West of Scotland Coronary Prevention Study: identification of high-risk groups and comparison with other cardiovascular intervention trials. Lancet 1996 Nov 16; 348: 1339–42.

    Article  Google Scholar 

  37. Brown WV. Review of clinical trials: proving the lipid hypothesis. Eur Heart J 1990; 11 Suppl. H: 15–20.

    Article  PubMed  Google Scholar 

  38. Downs JR, Clearfield M, Whitney E, et al. Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/ TexCAPS): preliminary results. 70th Annual Scientific Sessions of the American Heart Association; 1997 Nov 9–12; Orlando, Florida.

  39. Lipid Metabolism-Atherogenesis Branch National Heart Lung and Blood Institute. The Lipid Research Clinics Coronary Primary Prevention Trial results. II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA 1984; 251 (3): 365–74.

    Article  Google Scholar 

  40. Rackley CE. Monotherapy with HMG-CoAreductase inhibitors and secondary prevention in coronary artery disease. Clin Cardiol 1996 Sep; 19: 683–9.

    Google Scholar 

  41. Dujovne CA, Moriarty PM. Clinical pharmacologic concepts for the rational selection and use of drugs for the management of dyslipidemia. Clin Ther 1996 May-Jun; 18: 392–410.

    Google Scholar 

  42. Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995; 333: 1301–7.

    Article  PubMed  CAS  Google Scholar 

  43. Tonkin A. The long term intervention with pravastatin in ischaemic disease (LIPID) study results. Atherosclerosis 1998 Mar; 136 Suppl.: 39.

    Google Scholar 

  44. Betteridge DJ, Khan M. Review of new guidelines for management of dyslipidaemia. Baillieres Clin Endocrin Metab 1995 Oct; 9: 867–90.

    Google Scholar 

  45. Newman TB, Garber AM, Holtzman NA, et al. Problems with the report of the Expert Panel on Blood Cholesterol Levels in Children and Adolescents. Arch Pediatr Adolesc Med 1995 Mar; 149: 241–7.

    Google Scholar 

  46. Ramsay LE, Haq IU, Jackson PR, et al. The Sheffield table for primary prevention of coronary heart disease: corrected. Lancet 1996 Nov 2; 348: 1251–2.

    Article  PubMed  CAS  Google Scholar 

  47. Betteridge J et al. Use of statins: Sheffield tables have shortcomings. BMJ 1997 Dec 13; 315: 1619.

    PubMed  CAS  Google Scholar 

  48. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. National Cholesterol Education Program. Second report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II): II. Dietary therapy and physical activity. Circulation 1994; 89 (3): 1364–404, 1432–45.

    Google Scholar 

  49. Shepherd J, Betteridge DJ, Durrington P, et al. Strategies for reducing coronary heart disease and desirable limits for blood lipid concentrations. Guidelines of the British Hyperlipidaemia Association. BMJ 1987; 295: 1245–6.

    Article  PubMed  CAS  Google Scholar 

  50. Barnard RJ, DiLauro SC, Inkeles SB. Effects of intensive diet and exercise intervention in patients taking cholesterol—lowering drugs. Am J Cardiol 1997 Apr 15; 79: 1112–4.

    Article  PubMed  CAS  Google Scholar 

  51. Schrott HG, Bittner V, Vittinghoff E, et al. Adherence to national cholesterol education program treatment goals in postmenopausal women with heart disease: the Heart and Estrogen/Progestin Replacement Study (HERS). JAMA 1997 Apr 23–30; 277: 1281–6.

    Google Scholar 

  52. Pearson TA, Laurora IM. Attainment of LDL-cholesterol goals in a national sample: results from the Lipid Treatment Assessment Project. J Am Coll Cardiol 1998 Feb; 31 Suppl. 2A: 88.

    Article  Google Scholar 

  53. Cobbe SM, Shepherd J. Cholesterol reduction in the prevention of coronary heart disease: therapeutic rationale and guidelines. Br Heart J 1993 Jan; 69 Suppl.: S63–69.

    Article  PubMed  CAS  Google Scholar 

  54. Luepker RV. Reducing blood cholesterol levels in children: what have we learned from the DISC Study? JAMA 1995 May 10; 273: 1461–2.

    Article  PubMed  CAS  Google Scholar 

  55. Gordon BR, Saal SD. Current status of low density lipoproteinapheresis for the therapy of severe hyperlipidemia. Curr Opin Lipidol 1996 Dec; 7: 381–4.

    Google Scholar 

  56. Reckless JPD. Cost-effectiveness of hypolipidaemic drugs. Postgrad Med J 1993; 69 Suppl. 1: S30–33.

    PubMed  Google Scholar 

  57. Chong PH, Seeger JD. Atorvastatin calcium: an addition to HMG-CoA reductase inhibitors. Pharmacotherapy 1997 Nov-Dec; 17: 1157–77.

    Google Scholar 

  58. Garg A. Treatment of diabetic dyslipidemia. Am J Cardiol 1998; 81 (4A): 47B–51B.

    Article  PubMed  CAS  Google Scholar 

  59. van Boven AJ, Brügemann J, de Graeff PA, et al. The 4S study. Implications for prescribing. Drugs 1996; 51 (4): 507–14.

    Article  PubMed  Google Scholar 

  60. Stone NJ. Lipid management: current diet and drug treatment options. Am J Med 1996 Oct 8; 101 Suppl. 4A: 40S–49S.

    Article  CAS  Google Scholar 

  61. DiBianco R. Hypercholesterolaemia management guidelines. S Afr Med J 1992 Feb 15; 81 Suppl.: 4–9.

    Google Scholar 

  62. Haria M, McTavish D. Pravastatin: a reappraisal of its pharmacological properties and therapeutic use in the management of coronary heart disease. Drugs 1997; 53 (2): 299–336.

    Article  PubMed  CAS  Google Scholar 

  63. Britton ML, Bradberry JC, Letassy NA, et al. ASHP therapeutic position statement on the safe use of niacin in the management of dyslipidemias: an official ASHP practice standard. developed through the ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on September 26, 1997. Am J Health Syst Pharm 1997 Dec 15; 54: 2815–9

    Google Scholar 

  64. Adkins JC, Faulds D. Micronised fenofibrate: a review of its pharmacodynamic properties and clinical efficacy in the management of dyslipidaemia. Drugs 1997 Oct; 54: 615–33.

    Google Scholar 

  65. Tonstad S. A rational approach to treating hypercholesterolaemia in children: weighing the risks and benefits. Drug Saf 1997 May; 16: 330–41.

    Google Scholar 

  66. Bischoff H, Angerbauer R, Boberg M, et al. Cerivastatin: high enzyme affinity and active metabolites contribute to its high pharmacological activity. Atherosclerosis 1997 May; 130 Suppl.: 25.

    Article  Google Scholar 

  67. Bischoff H, Angerbauer R, Bender J, et al. Cerivastatin: pharmacology of a novel synthetic and highly active HMG-CoA reductase inhibitor. Atherosclerosis 1997 Nov; 135: 119–30.

    Google Scholar 

  68. Shaw MK, Newton RS, Sliskovic DR, et al. Hep-G2 cells and primary rat hepatocytes differ in their response to inhibitors of HMG-CoA reductase. Biochem Biophys Res Commun 1990; 170 (2): 726–34.

    Article  PubMed  CAS  Google Scholar 

  69. Jones P, Kafonek S, Laurora I, et al. Comparative dose efficacy study of atorvastatin versus simvastatin, pravastatin, lovastatin, and fluvastatin in patients with hypercholesterolemia (The CURVES study). Am J Cardiol 1998 Mar; 81 (5): 582–7.

    Article  PubMed  CAS  Google Scholar 

  70. McClellan KJ, Wiseman LR, McTavish D. Cerivastatin. Drugs 1998; 55 (3): 415–20.

    Article  PubMed  CAS  Google Scholar 

  71. Plosker GL, Wagstaff AJ. Fluvastatin: a review of its pharmacology and use in the management of hypercholesterolaemia. Drugs 1996 Mar; 51: 433–59.

    Google Scholar 

  72. Pedersen TR, Tobert JA. Benefits and risks of HMG-CoA reductase inhibitors in the prevention of coronary heart disease: a reappraisal. Drug Saf 1996 Jan; 14: 11–24.

    Google Scholar 

  73. Lennernäs H, Fager G. Pharmacodynamics and pharmacokinetics of the HMG-CoA reductase inhibitors: similarities and differences. Clin Pharmacokinet 1997 May; 32: 403–25.

    Google Scholar 

  74. Alberts AW. Effects of HMG CoA reductase inhibitors on cholesterol synthesis. Drug Invest 1990; 2 Suppl. 2: 9–17.

    Article  Google Scholar 

  75. O’Connor P, Feely J, Shepard J. Lipid lowering drugs. BMJ 1990 Mar 10; 300: 667–72.

    Article  PubMed  Google Scholar 

  76. Chrisp P, Lewis NJW, Milne RJ. Simvastatin: a pharmaco-economic evaluation of its cost-effectiveness in hypercholesterolaemia and prevention of coronary heart disease. PharmacoEconomics 1992 Feb; 1: 124–45.

    Google Scholar 

  77. Dujovne CA, Harris WS, Altman R, et al. Changes in hemorheology and atherothrombotic parameters by improving serum lipids in atorvastatin-treated hyperlipidemics [abstract]. 66th Congress of the European Atherosclerosis Society Abstract Book: 1996 Jul 13–17, Florence, 169.

  78. Naoumova RP, Marais D, Firth JC, et al. Atorvastatin augments therapy of homozygous familial hypercholesterolemia by inhibiting upregulation of cholesterol synthesis after apheresis and bile acid séquestrants [abstract]. Circulation 1996; 94 (8) Suppl.: I–583.

    Google Scholar 

  79. Lipitor™ (atorvastatin calcium) tablets. Data sheet. Parke-Davis, Division of Warner-Lambert Company, Morris Plains, NJ 07950, USA. 1996. (Data on file).

  80. Marais AD, Naoumova RP, Firth JC, et al. Decreased production of low density lipoprotein by atorvastatin after apheresis in homozygous familial hypercholesterolemia. J Lipid Res 1997; 38: 2071–8.

    PubMed  CAS  Google Scholar 

  81. Spencer CM, Barradell LB. Gemfibrozil: a reappraisal of its pharmacological properties and place in the management of dyslipidaemia. Drugs 1996 Jun; 51: 982–1018.

    Google Scholar 

  82. Rijpkema AHM, van der Sanden AA, Ruijs AHC. Effects of post-menopausal oestrogen-progestogen replacement therapy on serum lipids and lipoproteins: a review. Maturitas 1990; 12: 259–85.

    Article  PubMed  CAS  Google Scholar 

  83. Duell PB, Connor WE, Illingworth R. Rhabdomyolysis after taking atorvastatin with gemfibrozil. Am J Cardiol 1998; 81 (1): 368–9.

    Article  PubMed  CAS  Google Scholar 

  84. Gmerek A, Yang R, Bays H, et al. Atorvastatin causes a dose-dependent reduction in LDL-C and triglycérides [abstract]. 66th Congress of the European Atherosclerosis Society Abstract Book; 1996 Jul 13–17, Florence, 212.

  85. Nawrocki JW, Weiss SR, Davidson MH, et al. Reduction of LDL cholesterol by 25% to 60% in patients with primary hypercholesterolemia by atorvastatin, a new HMG-CoA re-ductase inhibitor. Arterioscler Thromb Vasc Biol 1995 May; 15: 678–82.

    Google Scholar 

  86. Heinonen TM, Stein E, Weiss SR, et al. The lipid-lowering effects of atorvastatin, a new HMG-CoA reductase inhibitor: results of a double-masked study. Clin Ther 1996; 18 (5): 853–63.

    Article  PubMed  CAS  Google Scholar 

  87. Heinonen T, Schrott H, Broyles F, et al. The effects of atorvastatin in postmenopausal women [abstract]. 66th Congress of the European Atherosclerosis Society AbstractBook; 1996 Jul 13–17; Florence, 56.

  88. Schrott H, Davila M, Black DM. The short-term effects of atorvastatin on lipid levels in patients with hyperlipidemia [abstract]. Atherosclerosis 1997 Oct; 134 (1–2): 120.

  89. Bakker-Arkema RG, Best J, Fayyad R, et al. A brief review paper of the efficacy and safety of atorvastatin in early clinical trials. Atherosclerosis 1997 May; 131: 17–23.

    Google Scholar 

  90. Japan Cholesterol Lowering Atorvastatin Study (J-CLAS) Group. Efficacy of atorvastatin in primary hypercholesterolemia. Am J Cardiol 1997 May 1; 79: 1248–52.

    Article  Google Scholar 

  91. Davidson M, McKenney J, Stein E, et al. Comparison of one-year efficacy and safety of atorvastatin versus lovastatin in primary hypercholesterolemia. Am J Cardiol 1997 Jun 1; 79: 1475–81.

    Article  PubMed  CAS  Google Scholar 

  92. Dart A, Jerums G, Nicholson G, et al. A multicenter, double-blind, one-year study comparing safety and efficacy of atorvastatin versus simvastatin in patients with hypercholesterolemia. Am J Cardiol. In press.

  93. Bakker-Arkema RG, Davidson MH, Goldstein RJ, et al. Efficacy and safety of a new HMG-CoA reductase inhibitor, atorvastatin, in patients with hypertriglyceridemia. JAMA 1996 Jan 10; 275: 128–33.

    Article  PubMed  CAS  Google Scholar 

  94. Bertolini S, Bon GB, Campbell LM, et al. Efficacy and safety of atorvastatin compared to pravastatin in patients with hypercholesterolemia. Atherosclerosis 1997 Apr; 130: 191–7.

    Google Scholar 

  95. Simons LA. Comparison of atorvastatin alone versus simvastatin ± cholestyramine in the management of severe primary hypercholesterolaemia (The Six Cities Study). Aust NZ J Med 1998; 28: 327–33.

    Article  CAS  Google Scholar 

  96. Naoumova RP, Marais AD, Firth JC, et al. Apheresis plus atorvastatin: a hard act for gene therapy to follow? [abstract]. 66th Congress of the European Atherosclerosis Society Abstract Book. 1996 Jul 13–17; Florence, 24.

  97. Naoumova RP, Marais AD, Mountney J, et al. Plasma mevalonic acid, an index of cholesterol synthesis in vivo, and responsiveness to HMG-CoA reductase inhibitors in familial hypercholesterolaemia. Atherosclerosis 1996 Jan 26; 119: 203–13.

    Article  PubMed  CAS  Google Scholar 

  98. Naoumova RP, Dunn S, Rallidis L, et al. Prolonged inhibition of cholesterol synthesis explains the efficacy of atorvastatin [abstract]. Atherosclerosis 1997 1–2, Oct No.; 134: 130.

    Google Scholar 

  99. Hilleman DE, Mohiuddin SM, Wurdeman RL, et al. The CURVES trial: a pharmacoeconomic evaluation. APOR Lipid Conference — Pharmacoeconomics and Outcomes Issues of Lipid Therapy 1997 Nov 6: Abstr. LC-19 (Poster).

  100. Nawrocki J, Shurzinske L, Black DM. Effectiveness of atorvastatin in treating patients to LDL-C goals compared with lovastatin, pravastatin and simvastatin [abstract]. Atherosclerosis 1997 1–2, Oct No.; 134: 120.

    Google Scholar 

  101. Smith DG, Bakker-Armenia RG, Mclain MJ. The use of add-on treatment in HMG-CoA reductase inhibitor therapy to achieve target lipid levels. APOR Lipid Conference — Pharmacoeconomics and Outcomes Issues of Lipid Therapy 1997 Nov 6: Abstr. LC-9.

  102. Sinzinger H, Granegger S, Ferlitsch A. Atorvastatin therapy for treatment of severe hypercholesterolemia in patients undergoing regular LDL-apheresis [abstract]. Atherosclerosis 1997 Oct; 134 (1–2): 61.

    Article  Google Scholar 

  103. Schettler V, Schuff-Werner P, Schettler E, et al. Effect of atorvastatin vs. simvastatin in patients undergoing regular LDL-aphersis (ASLAI) [abstract]. Atherosclerosis 1997 Oct; 134 (1–2): 133.

    Article  Google Scholar 

  104. Alaupovic P, Heinonen T, Shurzinske L, et al. Effect of a new HMG-CoA reductase inhibitor, atorvastatin, on lipids, apolipoproteins and lipoprotein particles in patients with elevated serum cholesterol and triglycéride levels. Atherosclerosis 1997 Aug; 133: 123–33.

    Google Scholar 

  105. Plosker GL, McTavish D. Simvastatin: a reappraisal of its pharmacology and therapeutic efficacy in hypercholesterolaemia. Drugs 1995 Aug; 50: 334–63.

    Google Scholar 

  106. McKenney JM, McCormick LS, Kafonek S, et al. Lipid lowering effects of atorvastatin, a new HMG-CoA reductase inhibitor, and niacin in patients with combined or isolated hypertriglyceridemia. Parke-Davis, Ann Arbor, Michigan, USA. (Data on file).

  107. Ooi TC, Heinonen T, Alaupovic P, et al. Efficacy and safety of a new hydroxymethylglutaryl-coenzyme A reductase inhibitor, atorvastatin, in patients with combined hyperlipidemia: comparison with fenofibrate. Arterioscler Thromb Vasc Biol 1997 Sep; 17: 1793–9.

    Google Scholar 

  108. McKenney J, McCormick L. The effect of atorvastatin and niacin on lipoprotein subclasses in patients with mixed hyperlipidemia [abstract]. Atherosclerosis 1997 1–2, Oct No.; 134: 58.

    Google Scholar 

  109. Nawrocki J, Schwartz S, Fayyad R, et al. Atorvastatin, a new HMG-CoA reductase inhibitor is safe and effective in NIDDM patients with hyperlipidemia [abstract]. 66th Congress of the European Atherosclerosis Society Abstract Book; 1996 Jul 13–17; Florenc, 222.

  110. Gmerek A, McLain R, Nawrocki J. A4-year, placebo-controlled study of atorvastatin as prevention of CHD endpoints in patients with non-insulin dependent diabetes mellitus [abstract]. Diabetes 1997 May; 46 Suppl. 1: 363A.

    Google Scholar 

  111. McCormick LS, Black DM, Waters D, et al. Rationale, design, and baseline characteristics of a trial comparing aggressive lipid lowering with atorvastatin versus revascularization treatments (AVERT). Am J Cardiol 1997 Nov 1; 80: 1130–3.

    Article  PubMed  CAS  Google Scholar 

  112. Serruys PW, Foley DP, Jackson G, et al. A randomized placebo-controlled trial of fluvastatin for the prevention of restenosis after successful coronary balloon angioplasty: results of the FLuvastatin Angioplasty REstenosis (FLARE) trial [Abstract no. P3598]. Eur Heart J 1997 Aug; 18: 620.

    Google Scholar 

  113. MAAS Investigators. Effect of simvastatin on coronary atheroma: the Multicentre Anti-Atheroma Study (MAAS). Lancet 1994 Sep 3; 344 (8923): 633–8.

    Article  Google Scholar 

  114. Negre-Aminou P, van Erck M, Cohen LH. Anti-proliferative potencies of 6 vastatins in cultured human cells; involvement of the ras-mediated signalling pathway [abstract]. 66th Congress of the European Atherosclerosis Society Abstract Book; 1996 July 13–17, Florence, 120.

  115. Ortego M, Bustos C, Hernez-Presa M, et al. The HMG-CoA reductase inhibitor atorvastatin reduces NF-kB activation and MCP-1 gene expression in vascular smooth muscle cells and mononuclear cells [abstract]. 66th Congress of the European Atherosclerosis Society Abstract Book: 1996 Jul 13–17, Florence, 66.

  116. Soma M, Piliego T, Seregni R, et al. Effect of atorvastatin on intimai carotid thickening induced by perivascular manipulation in normocholesterolemic rabbits [abstract]. 66th Congress of the European Atherosclerosis Society Abstract Book; 1996 Jul 13–17, Florence, 231.

  117. Simons LA, Celermajer DS, Sullivan D. Effects of atorvastatin or simvastatin plus cholestyramine on arterial endothelial function in primary hypercholesterolaemia [abstract]. Atherosclerosis 1997 Oct; 134 (1–2): 238.

    Article  Google Scholar 

  118. Carroll KK. Dietary protein, cholesterolemia and atherosclerosis. Can Med Assoc J 1992 Sep 15; 147: 900.

    CAS  Google Scholar 

  119. Pfieffer CM, Kazenoff S, Rothberg HD, et al. Toxic epidermal necrolysis from atorvastatin. JAMA 1998 May 27; 279: 1613–4.

    Article  Google Scholar 

  120. Wierzbicki AS, Lumb PJ, Semra YK, et al. Effect of atorvastatin on plasma fibrinogen. Lancet 1998 Feb 21; 351: 569–70.

    Article  PubMed  CAS  Google Scholar 

  121. Marais AD, Firth JC, Bateman ME, et al. Atorvastatin: an effective lipid-modifying agent in familial hypercholesterole-mia. Arterioscler Thromb Vasc Biol 1997 Aug; 17: 1527–31.

    Google Scholar 

  122. Athyros VG, Papageorgiou AA, Hatzikonstandinou HA, et al. Atorvastatin versus simvastatin on lipid profile and plasma fibrinogen in patients with hypercholesterolaemia: a pilot, dose-titrating study. Clin Drug Invest. In press.

  123. Stern RH, Yang B-B, Horton M, et al. Renal dysfunction does not alter the pharmacokinetics or LDL-cholesterol reduction of atorvastatin. J Clin Pharmacol 1997 Sep; 37: 816–9.

    Google Scholar 

  124. Newman TJ, Kassler-Taub KB, Gelarden RT, et al. Safety of pravastatin in long-term clinical trials conducted in the United States. J Drug Dev 1990; 3 Suppl. 1: 275–81.

    Google Scholar 

  125. Thompson GR. Adverse reactions profile: 10. Simvastatin and pravastatin. Prescr J 1990; 33: 217–20.

    Google Scholar 

  126. Johannesson M, Borgquist L, Nilsson-Ehle P, et al. The cost of screening for hypercholesterolaemia — results from a clinical trial in Swedish primary health care. Scand J Clin Lab Invest 1993; 53: 725–32.

    Article  PubMed  CAS  Google Scholar 

  127. O’Brien BJ. Cholesterol and coronary heart disease: consensus or controversy? 8. Questions of cost-effectiveness. London: From the Office of Health Economics 1991: 78–100.

    Google Scholar 

  128. Grover SA, Coupai L, Fahkry R, et al. Screening for hypercholesterolemia among Canadians: how much will it cost? Can Med Assoc J 1991; 144 (2): 161–8.

    CAS  Google Scholar 

  129. Davey Smith G, Song F, Sheldon TA. Cholesterol lowering and mortality: the importance of considering initial level of risk. BMJ 1993; 306: 1367–73.

    Article  Google Scholar 

  130. Caro J, Klittich W, McGuire A, et al. The West of Scotland Coronary Prevention study: economic benefit analysis of primary prevention with pravastatin. BMJ 1997 Dec 13; 315: 1577–82.

    Article  PubMed  CAS  Google Scholar 

  131. Goldman L, Garber AM, Grover SA, et al. Task force 6. Cost effectiveness of assessment and management of risk factors. J Am Coll Cardiol 1996; 27 (5): 964–1047.

    Article  Google Scholar 

  132. Johannesson M, Jönsson B, Kjekshus J, et al. Cost effectiveness of simvastatin treatment to lower cholesterol levels in patients with coronary heart disease. N Engl J Med 1997 Jan 30; 336: 332–6.

    Article  PubMed  CAS  Google Scholar 

  133. Smith DG, Bakker-Armenia RG, Mclain RW. The comparative effects of atorvastatin in achieving desired lipid levels following NCEP guidelines. APOR Lipid Conference — Pharmaco-economics and Outcomes Issues of Lipid Therapy 1997 Nov 6: Abstr. LC-8.

  134. Koren MJ, Smith DG, Hunninghake DB, et al. The cost of reaching National Cholesterol Education Program (NCEP) goals in hypercholesterolaemic patients: a comparison of atorvastatin, simvastatin, lovastatin and fluvastatin. Phar-macoeconomics 1998 Jul; 14 (1): 59–70.

    CAS  Google Scholar 

  135. Koren M, Tresh P, Smith D, et al. Cost of resource utilization of atorvastatin compared with fluvastatin, lovastatin and simvastatin in patients with risk factors for CHD [abstract]. Atherosclerosis 1997 1–2, Oct No.; 134: 52.

    Google Scholar 

  136. Koren M, Tresh P, Smith D, et al. Comparison of cost of resource utilization with atorvastatin versus fluvastatin, lovastatin and simvastatin in patients with CHD and/or PVD [abstract]. Atherosclerosis 1997 Oct 1–2; 134: 51.

    Google Scholar 

  137. Black D, Davidson M, Koren M, et al. Cost effectiveness of treatment to National Cholesterol Education Panel (NCEP) targets with HMG-CoA reductase inhibitors: trial design. Pharmacoeconomics 1997 Aug; 12 (Pt 2): 278–85.

    Google Scholar 

  138. Huse DM, Russell MW, Miller JD. Cost-effectiveness of HMG-Co A-reductase inhibition in primary prevention of CHD: new evidence comparing all available agents. APOR Lipid Conference — Pharmacoeconomics and Outcomes Issues of Lipid Therapy 1997 Nov 6: Abstr. LC-21 (Poster).

  139. Elliott WJ, Weir DR. Comparative cost-effectiveness of HMG-CoA reductase inhibitors in secondary prevention of myocardial infarction. APOR Lipid Conference — Pharmacoeconomics and Outcomes Issues of Lipid Therapy 1997 Nov 6: Abstr. LC-15.

  140. Miller JD, Huse DM, Russell MW, et al. Economic segmentation of statins: price versus efficiency [Abstract no. 1210-67]. J Am Coll Cardiol 1998 Feb; 31 Suppl. 2A: 486A.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Adis International Limited, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, Auckland 10, New Zealand

    Michelle I. Wilde & Caroline M. Spencer

Authors
  1. Michelle I. Wilde
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Caroline M. Spencer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michelle I. Wilde.

Additional information

Various sections of the manuscript reviewed by: P.H. Chong, Department of Pharmacy-Clinical Services, Cook County Hospital, Chicago, Illinois, USA; G.D. Johnston, The Queen’s University of Belfast, Department of Therapeutics and Pharmacology, Belfast, Northern Ireland; A.D. Marais, Department of Internal Medicine, University of Cape Town Medical School, Cape Town, South Africa; D.A. Playford, University Department of Medicine, Royal Perth Hospital, Perth, Western Australia, Australia; N. Sharpe, Department of Medicine, University of Auckland, Auckland Hospital, Auckland, New Zealand; A. Simon, Centre de Médécine Préventive Cardiovasculaire, Hôpital Broussais, Paris, France; H. White, Department of Cardiology, Greenlane Hospital, Auckland, New Zealand.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wilde, M.I., Spencer, C.M. Management of Dyslipidaemias. Dis-Manage-Health-Outcomes 3, 293–311 (1998). https://doi.org/10.2165/00115677-199803060-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-199803060-00004

Keywords

Search

Navigation