Cardiovascular disease (CVD) is a term used for disorders of the heart and/or blood vessels.

They are the second most leading cause of death in Canada after cancer, affecting about 8.5% of Canadians.

It usually starts with a build-up of fatty acids or plaques inside the wall of your blood vessels, narrowing them.

CVD can also occur due to damage of blood vessels in important organs such as the heart, brain, eyes, and kidneys.

This condition can cause disability or death if not managed. But the good news is that it can be prevented with the help of medicines and by leading a healthy lifestyle. 

Hyperlipidemia as the Cause of Cardiovascular Diseases

As mentioned before, fatty deposit inside the blood vessels is the major cause of cardiovascular diseases (CVD).

To know its effect on the heart and blood vessels, let us first understand a tad about cholesterol.

It is an oil-based substance and thus cannot mix with the blood. It travels in your blood bound to particles known as lipoproteins.

There are two types of lipoproteins:

  • Low-density lipoprotein (LDL): They carry cholesterol from the liver to your body cells. As it promotes cholesterol build-up in your blood vessels, cholesterol bound to LDL is known as LDL-cholesterol (LDL-C) or bad cholesterol.

  • High-density lipoprotein (HDL): This lipoprotein promotes the removal of excess cholesterol by carrying it from your cells to the liver, where it is metabolized. Cholesterol bound to this lipoprotein is thus known as HDL-cholesterol (HDL-C) or good cholesterol

A balance between LDL-C and HDL-C is essential for the functioning of cells. However, if the LDL-C builds up in your vessel wall, it may narrow and stiffen them, resulting in a condition known as atherosclerosis.

If this happens in blood vessels supplying your heart, it results in a lack of nutrition and oxygen supply to your heart muscles. This may ultimately cause angina or chest pain. When the blood supply to a major part of the heart muscle is cut off, it may cause a heart attack.

You may ask how much cholesterol is healthy?

Total cholesterol levels:

  • Normal: Less than 200 milligrams per deciliter (mg/dL)
  • Borderline high: Total cholesterol level between 200 and 239 mg/dL
  • High: Total cholesterol level of 240 mg/dL and above
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LDL cholesterol levels:

  • Normal: Less than 100 mg/dL
  • Borderline high: 130—159 mg/dL
  • High: 190 mg/dL or higher

HDL cholesterol levels:

  • Normal: 60 mg/dL or higher
  • Borderline low: 41— 59 mg/dL
  • Low: Less than 40 mg/dL

For preventing cardiovascular diseases, the main goal is to lower your LDL cholesterol levels. Eating a heart-healthy diet, lifestyle modifications, and cholesterol-lowering drugs, mainly statins, can help.

Your doctor will determine treatment options based on your cholesterol levels and other factors, such as the presence of other diseases.

How Atorvastatin Help Prevent Cardiovascular Disease?

Atorvastatin, available in the brand name of Lipitor, comes in the form of a tablet to be taken orally. It is a prescription drug used to improve cholesterol levels in dyslipidemia (abnormal cholesterol levels) patients. By improving cholesterol levels, it helps in preventing cardiovascular diseases such as stroke and heart failure. It works best when used along with weight loss, diet, and exercise. It can be used alone or in combination with other medicines for the same.

Here is how it works.

Atorvastatin belongs to a class of drugs called statins or HMG-CoA reductase inhibitors. 

This medicine works in two ways to lower your cholesterol levels:

  • It blocks the enzyme HMG-CoA reductase, responsible for cholesterol production, by binding at their active site. By reducing the production of cholesterol, it lowers the amount of cholesterol in your blood.
  • Atorvastatin also aids in reabsorbing the cholesterol present in your body. Cholesterol is essential for various functions such as making hormones, digesting food, and absorbing vitamin D. So, statins do not lower your cholesterol level. It reabsorbs the excess cholesterol present in your blood vessels in the form of plaques.

All in all, Atorvastatin lowers the level of LDL cholesterol and improves the level of HDL cholesterol. 

Lifestyle Changes

The following lifestyle modifications can boost the effect of Atorvastatin:

Prescription and Use

The mentioned dose is for general use. Your doctor may decide to alter the dose based on your condition.

Some factors that can help your doctor to decide a dose are:

  • Age
  • Health condition
  • Severity of your problem
  • Other medical conditions
  • Response to the medicine
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Atorvastatin is available in the following strengths: 10 mg, 20 mg, 40 mg, and 80 mg.

The general doses are as follows:

Prevention of heart disease

  • Adult dose: The beginning dose is 10–20 mg/ day. The maintenance dose can be between 10–80 mg/day.
  • Child dose: It is not approved for use in children to prevent cardiovascular diseases.
  • Senior dose: You may have a different dose or schedule based on your kidney function and the presence of other health conditions. 

For treating dyslipidemia

  • Adult dose: The beginning dose is 10–20 mg/ day. The maintenance dose can be between 10–80 mg/day.
  • Child dose: It is approved for use in children to manage heterozygous familial hypercholesterolemia. The recommended dose is 10 mg/day.
  • Senior dose: You may have a different dose or schedule based on your kidney function and the presence of other health conditions. 

How to Use It

  • Take this medication orally once a day with or without food or as prescribed by your physician.
  • Take this tablet daily at the same time.
  • Follow all the instructions on the prescription label. 
  • Do not stop taking this combination abruptly without consulting your doctor.
  • If you happen to miss a dose of Atorvastatin, take the missed dose as soon as you remember. 
  • However, if it is almost time for the next dose, do not take the missed dose and continue with your next scheduled dose. 
  • Do not take a double dose to compensate for the missed dose. 

Symptoms of overdose are:

  • Gas
  • Diarrhea
  • Heartburn
  • Forgetfulness
  • Confusion
  • Joint pain
  • Loss of appetite
  • Extreme muscle weakness, pain, or tenderness
  • Dark-colored urine
  • Upper stomach pain
  • Yellowing of the whites of your eyes or skin

If you have any of the mentioned symptoms, seek medical help immediately. 

Progress of Treatment-Short and Long Term

Your doctor will monitor your symptoms and cholesterol levels to understand the progress of the treatment in both the short term and long term.

Usually, your cholesterol levels should improve within four weeks if you take medicine regularly, as prescribed.

It may be possible that you will need to take Atorvastatin for your lifetime. The effect of the medicine persists till you continue to take it. Your cholesterol levels may become abnormal again if you stop taking Atorvastatin. 

While there are no withdrawal symptoms caused by stopping Atorvastatin, it may shoot your cholesterol levels, increasing the risk of cardiovascular diseases such as strokes and heart attacks.

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If you notice side effects and need to stop Atorvastatin, it should be done using alternative medicine after consulting your doctor. 

Some symptoms that indicate changing a dose or seeking medical help are:

  • Chest pain or discomfort
  • Breathlessness
  • A feeling of squeezing or pressure in the chest
  • Nausea or indigestion
  • Unusual fatigue
  • Anxiety
  • Sleep disturbances
  • Lightheadedness
  • Jaw pain
  • Pain in your shoulder, upper back, or throat
  • Pain in the center of your chest radiating to the arm

These symptoms may indicate worsening of the condition or a heart attack. If you have any of the mentioned symptoms, it is best to consult your doctor immediately.

Common Side Effects

Although Atorvastatin is safe, it may cause side effects in certain individuals.

Some side effects include:

Common: (Seen in 1 in 10 individuals)

  • Pain in the throat, inflammation of nasal passage, and nose bleed
  • High blood sugar levels
  • Headache
  • Nausea, vomiting, constipation, or diarrhea
  • Back pain
  • Muscle and joint pain

Uncommon: (Seen in 1 in 100 individuals)

  • Loss of appetite
  • Low blood sugar levels
  • Weight gain
  • Insomnia
  • Altered sensation to pain or touch
  • Dizziness
  • Numbness and tingling of toes and fingers
  • Ringing of ears
  • Change in taste
  • Fatigue
  • Neck pain
  • Chest pain

Rare: (Seen in 1 in 1000 individuals)

  • Severe allergic reaction (swelling of tongue, breathlessness, and dizziness)
  • Skin rash with peeling and blister formation
  • Muscle tenderness, weakness, or pain
  • Muscle breakdown (Rhabdomyolysis)
  • Kidney problems (symptoms such as a change in the amount of urine)
  • Visual disturbances

Very Rare: (Seen in 1 in 10,000 individuals)

  • Unusual or unexpected bleeding
  • Liver disorder (yellowing of the skin, dark urine, abdominal pain, and nausea and vomiting)
  • Gynecomastia (breast enlargement in men)

This is not a complete list of side effects, and others may occur. Please consult your doctor to know more about other possible side effects.

Final Thoughts

Cardiovascular disorders are highly prevalent and may result in complications, such as strokes and heart attack, if left unattended. However, managing the underlying cause and lifestyle modifications can help in managing or even preventing CVD. 

Atorvastatin is a common medication used to prevent cardiovascular diseases if a high cholesterol level is a problem.

You can work with your doctor, who will help decide a dose most suitable for you.

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