What is Lipitor?

Lipitor (generic name Atorvastatin), manufactured by Pfizer, is a member of a class of drugs called statins and is currently the top prescribed (as well as biggest earning) drug in the US.

Lipitor is an oral drug (taken in tablet form) that is used to lower cholesterol levels. It is normally prescribed when attempted changes in lifestyle have failed to reduce cholesterol levels to those generally recommended by the medical profession.

It is generally expected that cholesterol lowering treatment with Lipitor (or any statin) will need to be continued for the long-term (perhaps life) as cholesterol levels will rise again once the medication is ceased.

What is Lipitor Used to Treat?

Lipitor is used to help lower LDL cholesterol levels (for more information about cholesterol see the article: Cholesterol Explained).

However, high cholesterol is not a health problem in itself, but high LDLcholesterol levels have been associated with an increased risk of cardiovascular disease, so Lipitor is most commonly prescribed to try to treat or prevent heart disease.

Lipitor works by lowering the LDL (“bad”) cholesterol and triglycerides (another type of fat) in the blood, it may also help to increase levels of HDL (“good”) cholesterol as well. Clinical studies have shown that Lipitor lowers levels of LDL cholesterol by 39%-60% (with the effect depending on dose).

How Does Lipitor Reduce Cholesterol?

Lipitor, like all statins, works by inhibiting the production of an enzyme which plays an important role in the production of cholesterol in the liver. (For more information on statins see the article: Statins for Lowering High Cholesterol)

Dietary cholesterol contributes only a relatively small amount of the total cholesterol found in the body. The body actually manufactures most of its cholesterol from the fats and carbohydrates in our diet. Inhibiting the body’s manufacture of cholesterol can therefore have a significant impact on overall cholesterol levels.

How Effective is Lipitor at Treating or Preventing Heart Disease?

Some studies have shown that the use of statins can reduce LDL by 1.8 mmol/l (70 mg/dl) which, with long term use, may result in a 60% decrease in heart attacks and sudden cardiac deaths and a 17% reduced risk of strokes.

Other studies however, have produced results that indicate that Lipitor is not very effective at reducing the number of deaths from heart disease.

The manufacturers of Lipitor claim that the drug reduces the risk of heart attack by 36%. This figure was cited in an advert for Lipitor. However the small print of the ad provided additonal information about the study and the results. 

The study was of individuals with multiple risk factors for heart disease and the study showed that 3% of individuals in the control group (those taking a placebo or sugar pill) had a heart attack whereas in the group taking Lipitor 2% had a heart attack. In other words, there might be 1 less heart attack suffered in a group of 100 very high risk individuals taking Lipitor over a period of years.

Looking at it yet another way, this means that Lipitor does not benefit 99 out of every 100 high risk patients who take the drug. The number of people in a group who benefit from taking Lipitor falls even lower when the individuals taking the drug do not have multiple risk factors for, or pre-existing, heart disease.

In another advert for Lipitor (from 2004), included under the heading “important information” are the words “Lipitor has not been shown to prevent heart disease or heart attacks”.

Studies have also shown that patients suffering from heart failure (where the heart cannot pump enough blood to meet the body’s needs) actually do better when they have higher levels of cholesterol. Despite this, cholesterol lowering drugs such as Lipitor are commonly prescribed for these patients.

Prescribing of Lipitor

There are guidelines as to who should be prescribed Lipitor (or other statins) and who should not.

Who may be prescribed Lipitor?

Lipitor (or other statins) will usually be recommended to people who have cardiovascular disease and those who have had a heart attack, a stroke or TIA (Transient Ischemic Attack – sometimes known as a mini-stroke – causing brain dysfunction for less than 24 hours.)

There is some evidence to show that statins can help to lower the risk of these conditions worsening.

Lipitor may also be prescribed for individuals considered to be at high risk of developing cardio vascular disease. This preventative approach is controversial, with some studies indicating that it is effective and others concluding it is not. There is certainly data to strongly suggest that statin treatment does not offer benefits to women or the over 65s. Also, use of some statins is also associated with a slightly increased risk of diabetes, which is itself associated with an increased risk of heart disease.

Who should not take Lipitor?

 You must not take Lipitor if:

• You are pregnant (or think you may be pregnant) or are planning to become pregnant, since the baby will need cholesterol to develop properly and Lipitor reduces cholesterol. Using Lipitor when pregnant therefore may cause birth defects. If you get pregnant, stop taking Lipitor and consult your doctor immediately.
• You are breast feeding, as Lipitor may be able to pass into your breast milk and may harm your baby.
• You have liver disease or liver problems. Although serious liver damage caused by statins is rare, statins can cause anomolies in liver tests.
• You are allergic to Lipitor or any of its ingredients.

Lipitor Side Effects

Lipitor, like any drug, can cause side effects. Most of the literature says that Lipitor (and other statins) are generally well tolerated and that most side effects that occur will go away if you stop taking the medicine.

The truth of the matter is that Lipitor (and the other statins) can cause serious side effects as a direct consequence of the way they act on the body. As well as suppressing cholesterol production, statins suppress the synthesis of other important substances and this can have very serious implications, especially in the longer term.

For detailed information on the side effects that may be caused by taking Lipitor, see the article: Side Effects of Statins

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