When and how to start Statin therapy
American College of Cardiology/American Heart Association Task Force Clinical Practice Guidelines identifies high- intensity and moderate-intensity statin therapy for use in primary and secondary prevention of Cardiovascular disease.
When choosing a statin dose, expected LDL reduction is not the only factor to consider.
Dosage adjustment may be needed based on renal function, race, or drug interactions.
Key Points
Treatment depends on the specific lipid abnormality but should always include lifestyle changes, treatment of hypertension and diabetes, smoking cessation.
Both moderate- and high-intensity statin therapy reduce ASCVD risk, but a greater reduction in LDL-C is associated with a greater reduction in ASCVD outcomes.
Recommendation of statin therapy:
Statins are the only class of lipid-lowering therapy that has evidence for reduction of all-cause mortality (relative risk reduction of about 10%) and cardiovascular events (about 25%).
Statins are therefore recommended as first-line therapy in all patients for whom pharmaceutical intervention is considered.
For Primary Prevention:
|
Age |
LDL-C |
Additional Risk Factors |
Statin |
|
20-75 years |
≥190 mg/dl |
Without risk assessment |
high-intensity statin* |
|
40-75 years |
≥ 70 - <190 mg/dl |
With Diabetes & without calculating 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk |
moderate-intensity statin** |
|
40-75 years |
≥ 70 - <190 mg/dl |
Diabetes with risk enhancers & ASCVDrisk factor |
high-intensity statins
|
|
40-75 years |
≥ 70 - <190 mg/dl |
Without Diabetes and multiple ASCVDrisk factors |
high-intensity statin |
|
>75 years |
|
Clinical assessment and risk discussion |
|
For Secondary Prevention
|
Clinical ASCVD (not very high risk) |
||
|
Age |
Safety concerns |
Statin |
|
≤ 75 years |
No safety concerns |
*high-intensity statin |
|
≤ 75 years |
Not tolerated high-intensity statin |
**moderate-intensity statin |
|
> 75 years |
Or safety concerns |
moderate or high-intensity statin |
|
Clinical ASCVD (very high risk) |
||
|
|
|
High-intensity OR Maximal dose statin |
|
on maximal dose stain |
LDL-C ≥ 70 mg/dl |
High-intensity OR Maximal dose statin + Ezetimibe |
NOTES:
*High intensity statins are Atorvastatin 40-80 mg & Rosuvastatin 20 mg which Lowers LDL-C by ≥50%
**Moderate intensity statins are Atorvastatin 10 mg, Rosuvastatin 10 mg, Simvastatin 20-40 mg, Lovastatin 40 mg, Fluvastatin 40 mg twice daily.
(FDA recommends a lower starting dose (5 mg) and 50% of total dose reduction in treatment of Rosuvastatin in Asians patients than others.)
***The clinical diagnosis of atherosclerotic cardiovascular disease (ASCVD) includes
Acute coronary syndrome (ACS)
Myocardial infarction, also known as a heart attack
Stable or unstable angina or other arterial revascularization
Stroke and transient ischemic attack
Peripheral artery disease, including aortic aneurysm, all of atherosclerotic origin
Comments
You must login to write comment