Atorvastatin is a lipophilic HMG-CoA reductase inhibitor — the rate-limiting enzyme in cholesterol synthesis.
Mechanism — Reduces hepatic cholesterol production, upregulating LDL receptors on hepatocytes, which clear circulating LDL particles. Also has pleiotropic anti-inflammatory and plaque-stabilizing effects.
Use case — Primary and secondary cardiovascular prevention. Typical 10-80 mg/day. ApoB reduction of 30-50% at standard doses.
Caveats — Muscle pain in 5-10% of users (often dose-dependent and form-dependent). Slightly raises fasting glucose. CoQ10 depletion is real — supplement 100-200 mg/day. Don't avoid statins out of fear; the evidence in established CV disease is overwhelming.