A pharmacies most popular drug: Atorvastatin

Chemical structure of atorvastatin, showing functional groups such as -OH and -COOH and fluorophenyl groups. Image courtesy of DrugBank [1].

Pharmacies are equipped for prescribing hundreds of types of drugs to the public, but their most frequently prescribed drug in countries like England and the USA, is none other than atorvastatin.

Atorvastatin belongs to the statin class of drugs, which essentially helps lower cholesterol that is made inside your body. Cholesterol is made in the liver for cellular functions and is taken in through the diet, so people who naturally produce more cholesterol or people with unhealthy diets or smoking/drinking habits can benefit from this drug, where high cholesterol is affecting the cardiovascular system. It is very commonly prescribed to people who have had a negative cardiovascular event, such as a heart attack, or those with heart disease or are at high risk for heart disease [1].

The popularity of statins reflects a society with cardiovascular disease

Unfortunately, statins are a popularly prescribed drug for a reason. Cardiovascular diseases are the leading cause of death worldwide and most of these present as a heart attack or a stroke, where arteries are blocked from high cholesterol and oxygen cannot reach the heart or the brain. Other cardiovascular diseases include deep vein thrombosis, where there are blood clots in the legs that can travel to the brain and disrupt blood and oxygen flow, and diseases of blood vessels that supply blood and oxygen to the heart, brain and limbs. Cholesterol is involved in the process of blood vessel blockage through a process called atherosclerosis, where deposits of fat like cholesterol occur on blood vessel walls and block blood flow, and make the heart work harder to pump blood through narrowed vessels, which can also cause heart failure. Cholesterol itself does not cause cardiovascular diseases and is only a risk factor; other factors such as smoking, high consumption of alcohol, high blood sugar, low levels of exercise also heavily contribute to the development of these diseases, however high levels of low density cholesterol can indeed be harmful [2].

Many people do not realise they have cardiovascular issues until an acute event like a heart attack happens, however heart attacks can be immediately fatal, and so it is clear to see why this disease causes so many deaths. Immediate lifestyle changes and treatment is needed after a cardiovascular effect occurs, which modern medicine continues to revolutionise.

Statins mechanism of action and adverse effects

Statins like atorvastatin work by inhibiting an enzyme called HMG-CoA reductase, which means they block the conversion of HMG-CoA to mevalonic acid, and this structure is needed for the production of low-density cholesterol, or, "bad cholesterol". So with reduced levels of mevalonic acid, we have reduced cholesterol being produced in the liver, therefore there is less bad cholesterol in the body to cause cardiovascular diseases. This does not mean the patient is now immune from cardiovascular diseases, and diet must still be altered if unhealthy, however, the likelihood of developing diseases decreases, and cardiovascular health can be preserved, whether taken before or after a cardiovascular event. Atorvastatin, compared to other statins, is more potent, for patients with a more severe cholesterol reduction required [1]. Clinical trials have showed clear evidence that statins reduce risk of cardiovascular diseases, strokes and heart attacks, and for every 1mmol/L reduction in low density cholesterol, there's about a 22% reduced chance of these events [3].

Like any drug, atorvastatin can cause adverse effects that may be unpleasant for a user. Muscle pains are often recorded, and some users have experienced kidney injury. It also may increase the chance for a user to develop diabetes whilst on this drug, however the benefits of atorvastatin outweigh the risk for this, and patients should be demonstrating a better diet and more exercise which helps to offset diabetes development regardless. Historically, it is also not recommended to take statins while pregnant at all, as stopping cholesterol production has been thought to harm the growing foetus who needs cholesterol for it's development [4]. However, in recent years, the FDA have decided statins could be used for pregnant women who are at high risk of cardiovascular disease if needed, but this decision comes with more confusion for pregnant women over their choices of medication whilst pregnant, and fears of harming their growing foetus. Lack of research and trials conducted on pregnant women mean a lack of data about the safety of statins in pregnancy, so the decision to use statins during pregnancy is now a complex, individualized choice that must be made carefully between the patient and their doctor, weighing the immediate and severe risk of a cardiovascular event against the potential, though unproven, risks to the foetus [5].

A compound discovered from species of mould in the 1970s and becoming a fully synthetic drug in the 1990s, statins are a revolutionary drug which has helped decrease fatal cardiovascular diseases, and give patients a better quality of life and a better record of cardiovascular health. However, more research needs to be conducted into why some patients still have a residual risk of cardiovascular events, even after taking statins, and research into compounds that can decrease other lipids and inflammation is vital, as well as research into the effects of taking statins in pregnancy [6].

References:

1. DrugBank. Atorvastatin [Internet]. go.drugbank.com. 2025. Available from: https://go.drugbank.com/drugs/DB01076

2. World Health Organization. Cardiovascular diseases (CVDs) [Internet]. World Health Organization . 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

3. Nuffield Department of Population Health. Latest results from study into cost-effectiveness of statin therapy [Internet]. www.ndph.ox.ac.uk. Available from: https://www.ndph.ox.ac.uk/news/latest-results-from-study-into-cost-effectiveness-of-statin-therapy

4. McIver LA, Siddique MS. Atorvastatin [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430779/#article-55.s5

5. Mauricio R, Khera A. Statin Use in Pregnancy: Is It Time For a Paradigm Shift? Circulation. 2022 Feb 15;145(7):496–8.

6. Merćep I, Vujević A, Strikić D, Radman I, Pećin I, Reiner Ž. Present and Future of Dyslipidaemia Treatment—A Review. Journal of Clinical Medicine. 2023; 12(18):5839. https://doi.org/10.3390/jcm12185839

Assessed and Endorsed by the MedReport Medical Review Board