Related Experiment Video
Updated: Oct 2, 2026
A Neonatal Heterotopic Rat Heart Transplantation Model for the Study of Endothelial-to-Mesenchymal Transition
Published on: July 21, 2023
Safety and efficacy of atorvastatin in heart transplant recipients
Devang N Patel1, Francis D Pagani, Todd M Koelling
1Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA.
Insights
Atorvastatin effectively lowers LDL cholesterol in heart transplant patients when other statins fail. Moderate doses are safe and well-tolerated with monitoring, showing significant LDL reduction.
Area of Science:
- Cardiology
- Pharmacology
- Transplant Medicine
Background:
- Pravastatin and simvastatin offer modest LDL lowering and cardiovascular benefits in transplant recipients.
- Previous statin therapy often fails to achieve target LDL cholesterol levels (< 100 mg/dl).
Purpose of the Study:
- To evaluate the safety and efficacy of moderate-dose atorvastatin in heart transplant patients.
- To assess atorvastatin's effectiveness when prior statin treatment was insufficient for LDL reduction.
Main Methods:
- Retrospective analysis of 185 heart transplant patients.
- Evaluation of adverse events, exposure duration, and atorvastatin dosage.
- Monitoring of lipid parameters, prednisone, and cyclosporine levels.
Main Results:
- Atorvastatin (mean dose 21 mg) was used for 24,240 person-days in 48 patients.
- Adverse events (myositis, myalgias) were rare (2% each), mild, and reversible.
- LDL cholesterol decreased from 145 mg/dl to 88 mg/dl (37% reduction) during follow-up.
Conclusions:
- Moderate-dose atorvastatin is safe and effective for intensive LDL lowering in heart transplant recipients.
- Atorvastatin achieves LDL goals when other statins have failed, with careful monitoring.
- The drug is well-tolerated and reversible upon discontinuation.
Background:
Pravastatin and simvastatin prolong survival and reduce transplant-related coronary vasculopathy, although low-density lipoprotein (LDL) lowering with these agents is only modest. The objective of this study was to assess the safety of moderate dose atorvastatin and its efficacy when prior treatment with another statin had failed to lower LDL to < 100 mg/dl.
Methods:
Data from 185 patients were retrospectively evaluated for adverse events, duration of exposure (person-days), and the mean atorvastatin dose exposure. Changes in lipid parameters, and prednisone and cyclosporine doses were determined.
Safety:
48 patients received atorvastatin for 24,240 person-days at a mean dose exposure of 21 +/- 10 mg. Rhabdomyolysis, myositis, myalgias, and hepatotoxicity occurred in 0, 2, 2, and 0 patients, respectively. All events occurred at the 10-mg dose, within the first 3 months, and were rapidly reversible with atorvastatin discontinuation.
Efficacy:
Thirty-four patients evaluable for efficacy analyses had a pre-atorvastatin LDL of 145 +/- 38 mg/dl on the following statins: pravastatin (n = 30, 40 +/- 0mg), fluvastatin (n = 3, 33 +/- 12 mg), simvastatin (n = 1, 40 mg). After atorvastatin (21 +/- 9 mg/day) for 133 +/- 67 days, LDL was reduced to 97 +/- 24 mg/dl (relative reduction 31 +/- 20%, p < 0.0001). At the end of the observation period (418 +/- 229 days, atorvastatin final dose 24 +/- 14 mg/day), LDL was further decreased to 88 +/- 23 mg (relative reduction 37 +/- 17%, p < 0.0001).
Conclusion:
Atorvastatin, when used at moderate doses and with close biochemical and clinical monitoring, appears to be safe and is effective in aggressively lowering LDL in heart transplant recipients when treatment with other statins has failed to achieve LDL goals.
Related Concept Videos
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:26Atherosclerosis III: Management
01:28Kidney Transplant I: Introduction