Atorvastatin (Lipitor) What is it, what are the Side Effects and what can you do about them?

Heart disease kills one person every 36 seconds in the United States, and it is the leading cause of death for both men and women. About one in every four people dies as a result of heart disease.

 

Heart disease has many contributing factors, including high blood pressure and high blood cholesterol. High cholesterol is an epidemic in the United States, with an estimated 95 million American adults suffering from high cholesterol (total cholesterol levels of 200 mg/dL or higher) and 29 million American adults suffering from very high cholesterol (total cholesterol level of 240 mg/dL or higher), according to the Centers for Disease Control and Prevention (CDC).

 

Some people have high cholesterol levels due to genetic factors, but lifestyle factors such as unhealthy diets, sedentary lifestyles, and carrying around extra weight are usually the cause. High cholesterol levels are dangerous and increase your risk of experiencing heart disease, heart attack, and stroke as a result of a narrowing of the blood vessels that occurs when plaque builds up in the arteries.

 

Along with improving lifestyle and diet, many people take medication in order to control their high cholesterol and heart disease risk. The most popular medication for the treatment of high cholesterol is Lipitor, generically called atorvastatin.

 

While this medication is crucially important and has a long track record of reducing mortality, many people are concerned about the unpleasant side effects of statins such as atorvastatin. This article will explain what atorvastatin is, how it works, what are the common side effects and steps you can take to potentially mitigate these common complaints to carry on with confidence.

 

 

Overview

 

Atorvastatin, also sold under the brand name Lipitor, belongs to a class of drugs called statins that act  as HMG CoA reductase inhibitors that lower the amount of cholesterol the body produces. Atorvastatin is a prescription medication that is available in both brand name and generic forms.

 

Atorvastatin was the most commonly prescribed drug in the United States in 2017, when more than 104 million prescriptions were written for the medication. The high rate of prescriptions not only reflects the medication’s popularity, but also the epidemic level of high cholesterol facing Americans. 

 

Conditions Treated by Atorvastatin

 

Atorvastatin and other drugs like it, known as statins, are not only used to treat high cholesterol but also used to reduce the risk of cardiovascular disease and stroke, even in individuals with normal cholesterol levels. 

 

The understanding of heart disease has advanced tremendously over the last decade. Doctors now use multiple points of assessment to understand if a patient is at risk for heart disease and a good fit for a statin medication. 

 

These heart health factors:

• Blood pressure
• Cholesterol panel (Total cholesterol, LDL, HDL, triglycerides)
• Family history
• Body Mass Index (BMI)
• Blood glucose and A1C
• Inflammatory markers like C Reactive Protein (CRP)
• Coronary calcium score 
• Lifestyle factors such as smoking 

 

Statins are a powerful tool in the fight against heart disease and stroke, as they have been found to reduce the risk of cardiovascular events and lower mortality rates among people with the above risk factors.  

 

How Atorvastatin Works

 

For a long time statins have been thought of as purely cholesterol-lowering medications used to treat high cholesterol.  Statins like atorvastatin work by inhibiting an enzyme called HMG-CoA used to make cholesterol in the liver. But as time has gone on, statins are now viewed as risk-reducing medications that benefit individuals at high risk of heart disease or stroke but may not necessarily have high cholesterol.

 

Why this shift in thinking? Because we have learned more. Statins provide several  benefits beyond lowering cholesterol.

 

These are called pleiotropic effects. Think about it as the bonus benefits.

 

Statins are risk-reducing medications by:

• Decrease oxidative stress and inflammation. An important component to heart disease. 
• Improve endothelial function. A thin membrane that lines the inside of blood vessels that releases substances that control blood pressure, clotting, immune function and more. 
• Improve Nitric Oxide. This molecule dilates blood vessels and improves blood flow, an important aspect of cardiovascular health.
• Stabilize atherosclerotic plaque. Statins stabilize plaque by pulling cholesterol out of the waxy substance called plaque. Plaque can build up and cause blockage of blood flow to the heart or brain. 

 

Statins such as atorvastatin also work by the more traditionally understood mechanism of lowering cholesterol that include :

• Lowering bad cholesterol called LDL - think lousy for L
• Increasing good cholesterol called HDL - think healthy for H
• Lowering triglycerides - free floating fat in the bloodstream

 

By reducing the levels of bad cholesterol and triglycerides in the blood along with the pleiotropic effects, atorvastatin helps lower the risk of stroke, heart attack, and other complications in people with coronary heart disease, type 2 diabetes, and other risk factors. Statins are typically used in addition to lifestyle and dietary changes for the most protection. 

 

A quick lesson on cholesterol 

 

Cholesterol is a waxy, fat-like substance found in all the cells of your body and needed to strengthen cell membranes, make hormones and even used in the production of bile that helps you digest fats. Cholesterol comes from 2 sources: 1) the liver at about 75% and 2) diet at about 25%. While adequate amounts of cholesterol are important for certain functions in the body, elevated cholesterol levels can lead to deposits of this waxy-substance in blood vessels that can contribute to narrowing of arteries (atherosclerosis) and risk for a heart attack or stroke.

 

Cholesterol is transported in the body by sphere-shaped protein molecules called lipoproteins. Along with transporting cholesterol, these lipoproteins also transport other fats and fat-soluble nutrients to the tissues.

 

There are 2 main classes of lipoproteins

1. LDL: Low Density Lipoprotein 
2. HDL: High Density Lipoprotein

 

It’s important to note that both of these lipoproteins transport cholesterol. But WHERE and WHY they do it is the important aspect. 

 

LDL or low density lipoproteins are small, dense molecules that carry higher amounts of cholesterol and fat from the liver TO the cells of the body. This means if you have high levels of LDL in your bloodstream you could be transporting more fat and cholesterol to your tissues and blood vessels where it can deposit in the blood vessel wall, become oxidized and develop plaque that narrows the blood vessels, a process called atherosclerosis. This in turn slows or even blocks the flow of blood from the heart and other organs, which causes a higher risk of experiencing heart disease, heart attack, and stroke. Lower levels of LDL are ideal because that means you are at a lower risk of developing plaque buildup in your arteries. 

 

HDL or high density lipoproteins carry fat AWAY from your cells and back to the liver for breakdown. Having healthy levels of HDL can help to prevent the plaque buildup in blood vessel walls. Higher levels of HDL are ideal because that means you are at lower risk of developing plaque buildup in your arteries. 

 

Your total cholesterol is calculate by:

LDL + HDL + 20% triglycerides = Total Cholesterol 

 

If you have high cholesterol or are at risk for experiencing high cholesterol, it’s important to get your cholesterol levels tested regularly. Your doctors will use your total cholesterol numbers and the specific levels of HDL, LDL, and triglycerides in the body in order to formulate a treatment plan that will help you lower your cholesterol safely.

 

There are also other lipoprotein classes and subclasses that some cardiologists may look at to better assess your overall risk and fit for statin medications such as atorvastatin.

 

Atorvastatin Side Effects

 

Every medication comes with the potential for side effects. Atorvastatin’s side effect profile is similar to other cholesterol-lowering medications in the statin category. It is important that you discuss any potential side effects with your prescribing health care provider.

 

Commonly reported side effects include:

• Muscle pain and weakness
• Stiffness and tenderness 
• Headache
• Fatigue
• Nausea 
• Digestive distress - constipation, diarrhea, flatulence 
• Sleep problems 
• Elevated blood sugars

 

While the causes for many of these side effects are poorly understood, nutrient depletions may be responsible for some of them. In fact, Medication Induced Nutrient Depletions (M.I.N.D) is well documented in decades of pharmacology research. 

 

Statins work by inhibiting the mevalonate pathwaySpecifically, the World Health Organization has stated that hormonal birth control may deplete the body of key nutrients including folate, vitamins B2, B6, B12, vitamin C and E, and the minerals magnesium, selenium, and zinc. It’s also stated that this should be addressed with nutrient therapy to balance the body8. 

 

This is because nutrient depletions may lead to changes in biochemistry and impact different systems in your. They can include the following:

 

• Inflammatory Control

 

Women using hormonal contraceptives have higher levels of inflammation in their blood (lipid peroxidase and C-reactive protein). If left unchecked, these may contribute to symptoms associated with increased inflammation such as headaches, fatigue, and depression 4, 5, 6, 7, 8. In interventional studies, therapeutic doses of antioxidants normalized inflammatory markers5.

 

• Mood & Sleep

 

Research shows that 80% of women using contraceptives like Nexplanon have altered tryptophan metabolism within 30-90 days of initiation of use6, 7. This pattern has been correlated with depression, anxiety, and low libido in OC users and has been corrected with therapeutic vitamin B6 doses8, 9. Tryptophan is an important amino acid used to make “feel good” serotonin and “sleep well” melatonin as well as a molecule responsible for regulating inflammation and even blood sugar. 

 

• Thyroid Function

 

The thyroid gland is a butterfly shaped gland located at the base of the neck responsible for making thyroid hormone that regulates body temperature, metabolism, energy levels, hair growth, skin appearance, gut health, and more. The nutrients depleted on birth control are important for proper thyroid function. Without adequate levels of these nutrients, thyroid function may be suboptimal.

 

• Sex Drive

 

Libido is a complex topic with multifaceted reasons for alterations in drive. Some women experience an increased sex drive on Nexplanon (no fear of pregnancy!) while others see a decrease. Because the hormones in birth control are designed to prevent ovulation, there may be a shift in hormones such as estrogen and testosterone along which can negatively impact libido11.  

 

• Mitochondrial Health

 

Mitochondria are little energy generators that make energy in the form of ATP in every cell. They’re important for energy levels, brain health, hormonal production, and balancing inflammation. They also run on nutrients that birth control depletes.  

 

• Liver Function 

 

It’s important that the liver metabolizes the hormones in birth control so that the hormonal metabolites don’t stick around and exert too much of an effect. The liver requires several key nutrients to function properly and unfortunately, several of these are depleted by birth control. Ensuring that you have adequate amounts of nutrients such as vitamins C and E, zinc and B vitamins will help your liver function optimally13. 

 

 

Can the side effects of Nexplanon be prevented or avoided?

 

There are several actions you can take to minimize common complaints with Nexplanon. They include the following steps:

 

Assess yourself before you start

 

Keep a journal. Start tracking your mood, digestive health, PMS, headaches and more  before you begin hormonal contraceptives and continue throughout your course in order to determine if changes may be linked to their use of contraceptives. 

 

Take your medical history into account

 

Work with your healthcare professional and review your medical history as well as your family history. Individuals with a history of depression or family history of mood disturbances and mental illness may be at higher risk for experiencing depression with birth control. 

 

Factor in your lifestyle 

 

Focus on staying hydrated, getting quality sleep, eating nutrient rich foods and less junk food, aiming for movement most days of the week, and finding meaningful community and work. This can go very far to support your mental well being while using birth control

 

Monitor your bloodwork 

 

Work with your healthcare professional to monitor biomarkers associated with depression and birth control use. These include stress markers such as cortisol, inflammatory markers such as lipid peroxidase and c-reactive protein along with key nutrients known to be depleted while using birth control (B12 as MMA, folate as FIGLU, B6 as xanthurenic acid, red blood cell magnesium and more).

 

Tap into nutrient therapy 

 

Medication Induced Nutrient Depletions (M.I.N.D.) are important to address to ensure long term success with your medication use. Using therapeutic doses of required nutrients can ensure a great tolerance of your birth control long term. 

 

Every medication has benefits and risks, but knowledge is power. Talk to your healthcare professional about your unique medication history and health goals. There are many ways to get the benefits of birth control while still feeling your best. 

 

Commonly reported side effects include:

• Muscle pain and weakness
• Stiffness and tenderness 
• Headache
• Fatigue
• Nausea 
• Digestive distress - constipation, diarrhea, flatulence 
• Sleep problems 
• Elevated blood sugars

 

Other side effects of atorvastatin are less common but can be more serious and do require medical attention. Make sure to speak to your doctor right away if you experience any of the following uncommon but serious side effects while taking atorvastatin:

 

 

How to Reduce Atorvastatin Side Effects

 

Atorvastatin is an important medication that many people rely on to keep their cholesterol levels in check. However, the side effects of the medication can be unpleasant and cause people to resist taking their medications because they do not want to experience uncomfortable side effects. It is believed that some side effects of statins like atorvastatin are caused by the depletion of coenzyme Q-10, or CoQ10, in the body.

 

CoQ10 is an important antioxidant that is naturally produced by the human body as a byproduct of the cellular respiration process, which is the process by which cells create the energy we need to function. CoQ10 is responsible for preventing the cellular and DNA damage caused by free radicals, which are another byproduct of cellular respiration.

 

Atorvastatin and other statins contribute to lower levels of CoQ10 in the body, which can cause higher levels of inflammation and damage to the cells and mitochondria. Therefore, it may be possible to reduce atorvastatin side effects by boosting CoQ10 levels in the body through dietary supplements. 

 

Dietary supplements designed to support statin use, such as Statin Support by Even, provide vitamins B1, B2, and B3, vitamin K2, sulforaphane, selenium, vitamin D3, and Resveratrol in addition to CoQ10. Vitamins B1, B2, and B3 have been found to support mitochondrial health by helping to reduce the levels of lactic acid that may contribute to muscle symptoms.

 

Vitamin K2 can help prevent arterial calcification that is caused by cholesterol, while selenium provides selenoproteins that contribute to redox balance. Resveratrol is an antioxidant that can help reduce muscle pain from statins by supporting the health of the mitochondria, while sulforaphane helps mitigate the risk of insulin resistance that some patients experience.

 

Dietary supplements  that are specifically designed to provide bioavailable CoQ10, vitamins B1, B2, and B3, vitamin K2, and chelated minerals and mitochondrial antioxidants that help support biochemical balance in the body can help minimize the experience of side effects resulting from atorvastatin. 

 

 

Groups That Should Avoid Atorvastatin

 

While nutritional support can help reduce side effects associated with atorvastatin, the medication can be dangerous for certain groups of people. Atorvastatin should not be taken by people who are allergic to it or to other statins.

 

People who meet some or all of the following criteria should not take the medication without consulting with their healthcare professional:

• People who have had any of the following conditions should exercise caution:
• Diabetes
• Muscle pain, muscle aches, muscle problems, or weakness
• Kidney disease or kidney problems
• Thyroid disorder
• People experiencing any of the following conditions may need to briefly stop taking atorvastatin:
• Surgery or medical emergency
• Uncontrolled seizures
• Severely low blood pressure
• Electrolyte imbalance, such as high or low levels of potassium
• Severe infection of illness
• People with liver disease
• Women taking birth control pills should talk to their doctors about hormone interactions. 
• People who drink more than two alcoholic beverages per day
• Women who are pregnant or planning to become pregnant.
• Women who breast-feed should not take atorvastatin.

 

 

 

 

 

Sources:

https://medlineplus.gov/druginfo/meds/a600045.html#side-effects 

https://clincalc.com/DrugStats/Drugs/Atorvastatin 

https://www.healthline.com/health/high-cholesterol/statins-list-of-common-types 

https://www.healthline.com/health/high-cholesterol/why-statin-drugs-may-be-bad-for-you 

https://www.healthline.com/health/coq10-and-statins#benefits 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096178/ 

https://www.cdc.gov/heartdisease/facts.htm 

https://ipccs.org/2019/02/20/inverse-association-between-long-term-statin-adherence-and-all-cause-mortality-in-ascvd/ 

https://www.ahajournals.org/doi/full/10.1161/01.cir.0000131517.20177.5a