Via practica 5/2016

Comparison of efficacy and safety of atorvastatin in a dosage of 20 mg and 30 mg in general practitioners’ practice

Introduction: Dyslipidemia is a major risk factor for cardiovascular diseases. Its diagnosis and treatment are not only in the hands of specialists, but especially general practitioners (GP). Despite the existence of effective and safe treatment with statins many patients in Slovakia do not reach the target lipid levels. The goal of the study was to compare the efficacy and safety of atorvastatin (ATST) at a dose of 30 mg compared with 20 mg in patients without previous statin treatment in GP practice. Methods: The study included 668 patients assigned to treatment by ATST 20 mg (330 patients) or 30 mg (338 patients), at the discretion of the treating GP. Lipids were determined at the beginning of the study and after 3 and 6 months. Alanine aminotransferase (ALT) and creatine kinase (CK) were monitored as safety markers. Results: The average input values of total cholesterol (TC) were 6.56 ± 1.04 mmol/l, LDL 4.18 ± 1.02 mmol/l, HDL 1.42 ± 0.60 mmol/l, nonHDL 5.16 ± 1.06 mmol/l, triacylglycerols (TAG) 2.00 ± 0.99 mmol/l, ALT 0.52 ± 0.44 ukat/l and CK 1.72 ± 0.84 ukat/l. After 6 months there was a significant decrease of TC 1.55 ± 0.05 mmol/l, LDL of 1.16 ± 0.04 mmol/l, nonHDL of 1.59 ± 0.04 mmol/l, the TAG 0.42 ± 0.04 mmol/l. Patients taking 30 mg ATST achieved greater decreases in TC, LDL and nonHDL compared to the patients who are taking ATST 20 mg (TC: 1.64 ± 0.06 mmol/l versus 1.46 ± 0.06 mmol/l, difference of 12 %; p < 0,05, LDL: 1.29 ± 0.07 mmol/l versus 1.04 ± 0.05 mmol/l, difference of 24 %; p < 0.01, nonHDL: 1.70 ± 0.07 mmol/l versus 1.49 ± 0.06 mmol/l, difference 14 %; p < 0.05). We observed no significant difference in ALT, there was a slight increase in CK (0.15 ± 0.04 ukat/l; p < 0.001). Conclusion: Patients treated with 30 mg ATST reached 12 % greater decrease in TC, 24 % greater decrease in LDL and a 14 % decrease nonHDL higher in patients treated with 20 mg ATST. ATST therapy has been shown to be effective and safe, it was observed only a slight increase in CK, but not recorded an increase of 3 times the normal value. Treatment with atorvastatin 30 mg is an optimal dose for wide spectrum of patients in GP practice, because it is more effective and equally safe alternative to most commonly used 20 mg dose of atorvastatin.

Keywords: general practitioner, atorvastatin, target lipid values