Atorvastatin: Understanding Side Effects, Muscle Myopathy, and Liver Enzyme Elevation in Statin Therapy

Atorvastatin is one of the most widely prescribed statins globally, primarily used to lower cholesterol levels and prevent cardiovascular events. However, like any medication, its use is not without side effects. Among the most significant are myopathy and elevation of liver enzymes, which can lead to more serious complications such as rhabdomyolysis. This article explores these effects and the importance of clinical monitoring to minimize risks.

Diving Deeper into Atorvastatin Side Effects

Statin-induced myopathy is a well-documented adverse effect, characterized by muscle pain, weakness, and, in severe cases, rhabdomyolysis. Studies have identified genetic variants, such as the SLCO1B1*5 allele, that increase susceptibility to these effects [1]. Furthermore, the correlation between atorvastatin metabolite levels in plasma and muscle tissue suggests that plasma measurements may serve as a good indicator of muscle exposure to the drug [2].

Regarding elevation of liver enzymes, although less common, it can be a sign of liver damage. The activation of antioxidant pathways, such as those mediated by Nrf2, has shown protective effects against atorvastatin-induced hepatotoxicity [3]. Regular monitoring of liver enzymes is crucial for early detection of any abnormalities.

Conclusions and Clinical Recommendations

Atorvastatin remains a valuable therapeutic option for cholesterol reduction and cardiovascular disease prevention. However, it is essential for physicians to be vigilant about potential side effects, especially in patients with genetic risk factors or those taking concomitant medications that may increase systemic exposure to the statin. Regular monitoring of muscle and liver function is fundamental to ensure patient safety and optimize treatment outcomes.

In summary, personalizing treatment based on the patient's genetic profile and rigorous clinical follow-up can help mitigate the risks associated with atorvastatin, ensuring its safe and effective use.

Referencias

• [1] SLCO1B1*5 Allele Is Associated With Atorvastatin Discontinuation and Adverse Muscle Symptoms in the Context of Routine Care.
• [2] Atorvastatin Metabolite Pattern in Skeletal Muscle and Blood from Patients with Coronary Heart Disease and Statin-Associated Muscle Symptoms.
• [3] Aldo-keto reductase-7A2 protects against atorvastatin-induced hepatotoxicity via Nrf2 activation.

Created 6/1/2025