Safety Outcomes of Atorvastatin 80 mg Versus Atorvastatin 40 mg in a Veteran Population

Background: High-intensity atorvastatin dosing may lead to a greater incidence of adverse events, subsequently leading to discontinuation and suboptimal risk reduction for major adverse cardiovascular events. No previous studies exist investigating the safety of high-intensity atorvastatin therapy among a veteran population. Objective: To evaluate the safety profile of high-intensity atorvastatin in the veteran population. Methods: This was a retrospective observational study conducted on patients newly prescribed atorvastatin 80 or 40 mg daily at the Memphis Veterans Affairs Medical Center. The primary outcome was incidence of adverse drug events. Secondary outcomes include incidence of high-intensity atorvastatin discontinuation and change of lipid panel values. Results: A total of 205 veterans were analyzed among atorvastatin 80 mg daily (n = 103) and atorvastatin 40 mg daily (n = 102) groups. Of 40 adverse events reported, 23 events occurred with atorvastatin 80 mg and 17 events with atorvastatin 40 mg (P = 0.31). Myalgia (11% vs 7%; P = 0.33) and weakness (12% vs 9%; P = 0.51) were commonly reported events among both cohorts. Rates of discontinuation of high-intensity atorvastatin therapy were similar between cohorts (26% vs 15%; P = 0.45). No statistically significant differences in lipid profile reductions were found. Conclusion and Relevance: Atorvastatin 80 mg daily was well tolerated with similar incidence of discontinuation and reduction of lipid panel values compared with atorvastatin 40 mg daily in a veteran population. This study provides a direct comparison of safety outcomes for high-intensity atorvastatin doses among veterans to highlight the importance of clinician-patient discussion on statin-related adverse effects compared with desired efficacy when considering initiation of therapy.