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This structured narrative review critically reappraises its safety profile by integrating evidence from randomized trials, meta\u2010analyses, observational studies, pharmacovigilance analyses, case reports, and preclinical models. Evidence is interpreted according to study design, with controlled and synthesized human data guiding clinical conclusions and lower level evidence treated as supportive or hypothesis\u2010generating. Overall, atorvastatin provides substantial cardiovascular protection, whereas serious adverse reactions are uncommon. The principal clinical concerns are statin\u2010associated muscle symptoms, hepatic laboratory abnormalities, drug\u2013drug interactions, and a small dose\u2010 and susceptibility\u2010dependent increase in new\u2010onset diabetes. Safety is shaped by dose, comorbidities, interacting medicines, pharmacokinetic variability, and transporter variants, particularly SLCO1B1, although the clinical actionability of other pharmacogenomic markers remains limited. We, therefore, emphasize individualized risk assessment, interaction review, appropriate monitoring, dechallenge and rechallenge, dose adjustment, alternative statins, and nonstatin combination therapy when needed. Experimental delivery systems and mechanistic findings may inform future strategies but do not yet establish improved clinical safety. Taken together, the evidence supports a benefit\u2010centered, evidence\u2010stratified framework that addresses genuine toxicity without overstating uncertain safety signals or unnecessarily discontinuing effective therapy.<\/jats:p>","DOI":"10.1155\/cdr\/4127131","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T05:44:25Z","timestamp":1791006265000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Atorvastatin Safety Reappraised: From Pharmacogenomic Mechanisms to Personalized Risk Management"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0792-3316","authenticated-orcid":false,"given":"Hanyu","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine Zhongnan Hospital of Wuhan University  Wuhan Hubei Province China  znhospital.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Zhongnan Hospital of Wuhan University  Wuhan Hubei Province China  znhospital.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0236-9840","authenticated-orcid":false,"given":"Yiming","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine Zhongnan Hospital of Wuhan University  Wuhan Hubei Province China  znhospital.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5432-9570","authenticated-orcid":false,"given":"Pan","family":"Zhai","sequence":"additional","affiliation":[{"name":"Department of Integrated Traditional Chinese Medicine and Western Medicine Zhongnan Hospital of Wuhan University  Wuhan Hubei Province China  znhospital.cn"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"key":"e_1_2_13_1_2","doi-asserted-by":"publisher","DOI":"10.1002\/pdi.2450"},{"key":"e_1_2_13_2_2","doi-asserted-by":"publisher","DOI":"10.1517\/14740338.2010.495385"},{"key":"e_1_2_13_3_2","unstructured":"US Food and Drug Administration LIPITOR (Atorvastatin Calcium) Tablets: Prescribing Information 2024."},{"key":"e_1_2_13_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008226.pub3"},{"key":"e_1_2_13_5_2","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-200342130-00005"},{"key":"e_1_2_13_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1515161"},{"key":"e_1_2_13_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23158364"},{"key":"e_1_2_13_8_2","doi-asserted-by":"publisher","DOI":"10.2174\/1574886318666230227143627"},{"key":"e_1_2_13_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/85.5.459"},{"key":"e_1_2_13_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.07.022"},{"key":"e_1_2_13_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016604"},{"key":"e_1_2_13_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjcvp\/pvaa076"},{"key":"e_1_2_13_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2006.04.013"},{"key":"e_1_2_13_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00204-025-04222-w"},{"key":"e_1_2_13_15_2","doi-asserted-by":"publisher","DOI":"10.1155\/cdr\/6684099"},{"key":"e_1_2_13_16_2","doi-asserted-by":"publisher","DOI":"10.7326\/M24-0178"},{"key":"e_1_2_13_17_2","doi-asserted-by":"publisher","DOI":"10.1592\/phco.23.15.1663.31953"},{"key":"e_1_2_13_18_2","doi-asserted-by":"publisher","DOI":"10.3390\/ph15121536"},{"key":"e_1_2_13_19_2","doi-asserted-by":"publisher","DOI":"10.5414\/CP204025"},{"key":"e_1_2_13_20_2","first-page":"495","article-title":"Side Effects of the HMG-CoA Reductase Inhibitors (Statins). 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