Atorvastatin for the primary and secondary prevention of CVD Potential impact of implementation Since the 2008 guideline on lipid modification was published, atorvastatin has come off- patent and is available at a reduced cost, therefore making it more cost effective. Atorvastatin is more potent than other non-generic statins and has a lower risk of adverse interactions with other drugs. There is also greater compatibility with other cardiovascular and lipid modifying therapies. In addition, atorvastatin does not have to be taken at night, which may increase convenience. Challenges for implementation The rationale for recommending atorvastatin over other statins may not be well understood, both when starting treatment for people with a 10% CVD risk or greater and when prescribing statins for people with existing CVD. Prescribers may be uncertain about switching existing patients to atorvastatin from other statins, and may perceive there to be an impact on their workload in doing so. Support for implementation A meta-analysis of studies with statins was conducted after statins were classified into high-, medium- and low-efficacy groups based on their efficacy in lowering LDL cholesterol levels. High-efficacy statins at low acquisition cost (for example, atorvastatin 20 mg or greater) were more effective than moderate-intensity statins (simvastatin 20 mg or atorvastatin 10 mg) in reducing cardiovascular outcomes. This increment in therapy was cost effective, with high-intensity statin therapy reducing CVD events by an extra 9 to 12 per thousand fatal and non-fatal heart attacks and stroke events in this comparison. People admitted for acute coronary syndromes are likely to have been prescribed atorvastatin 80 mg on the basis of recommendations made in the 2008 guideline. Therefore, only people with chronic CVD would need to be considered for conversion to high-dose, high-intensity statin (atorvastatin 80 mg). 