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A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. If the increase is mild, you can continue to take the drug. © Copyright David Leonardi, M.D. To see the full article, log in or purchase access. When choosing a statin dose, expected LDL reduction is not the only factor to consider. Copyright © 2020 American Academy of Family Physicians. a 31% to 40% reduction is medium intensity. Encourage heart-healthy lifestyle habits for all individuals, Initiate or continue appropriate intensity of statin therapy, Age ≤ 75 years and no safety concerns: high-intensity statin (COE = I; LOE = A), Age > 75 years or safety concerns: moderate-intensity statin (COE = I; LOE = A), Primary prevention: primary LDL-C ≥ 190 mg per dL (4.92 mmol per L), Rule out secondary causes of hyperlipidemia (see Table 6 in full guideline), Age ≥ 21 years: high-intensity statin (COE = I; LOE = B), Achieve at least a 50% reduction in LDL-C (COE = IIa; LOE = B), Consider LDL-C–lowering nonstatin therapy to further reduce LDL-C (COE = IIb; LOE = C), Primary prevention: persons 40 to 75 years of age with diabetes mellitus and with LDL-C of 70 to 189 mg per dL (1.81 to 4.90 mmol per L), Moderate-intensity statin (COE = I; LOE = A), Consider high-intensity statin when ≥ 7.5% 10-year ASCVD risk using the Pooled Cohort Equations† (COE = IIa; LOE = B), Primary prevention: persons 40 to 75 years of age without diabetes and with LDL-C of 70 to 189 mg per dL, Estimate 10-year ASCVD risk using the risk calculator based on the Pooled Cohort Equations† in those not receiving a statin; estimate risk every 4 to 6 years (COE = I; LOE = B), To determine whether to initiate a statin, engage in a clinician-patient discussion of the potential for ASCVD risk reduction, adverse effects, drug-drug interactions, and patient preferences (COE = IIa; LOE = C), Reemphasize heart-healthy lifestyle habits and address other risk factors, • ≥ 7.5% 10-year ASCVD risk: moderate- or high-intensity statin (COE = I; LOE = A), • 5% to < 7.5% 10-year ASCVD risk: consider moderate-intensity statin (COE = IIa; LOE = B), • Other factors may be considered‡: LDL-C ≥ 160 mg per dL (4.14 mmol per L), family history of premature cardiovascular disease, high-sensitivity C-reactive protein ≥ 2 mg per L (19.05 nmol per L), coronary artery calcium score ≥ 300 Agatston units, ankle-brachial index < 0.9, or elevated lifetime ASCVD risk (COE = IIb; LOE = C), Primary prevention when LDL-C < 190 mg per dL and age < 40 or > 75 years, or < 5% 10-year ASCVD risk, Statin therapy may be considered in select individuals‡ (COE = IIb; LOE = C), Statin therapy is not routinely recommended for individuals with New York Heart Association class II to IV heart failure or who are receiving maintenance hemodialysis, Regularly monitor adherence to lifestyle and drug therapy with lipid and safety assessments, Assess adherence, response to therapy, and adverse effects within 4 to 12 weeks following statin initiation or change in therapy (COE = I; LOE = A), Measure fasting lipid levels (COE = I; LOE = A), Do not routinely monitor alanine transaminase or creatine kinase levels unless symptomatic (COE = IIa; LOE = C), Screen and treat type 2 diabetes according to current practice guidelines; heart-healthy lifestyle habits should be encouraged to prevent progression to diabetes (COE = I; LOE = B), Anticipated therapeutic response: approximately ≥ 50% reduction in LDL-C from baseline for high-intensity statin and 30% to < 50% for moderate-intensity statin (COE = IIa; LOE = B), • Insufficient evidence for LDL-C or non–HDL-C treatment targets from RCTs, • For those with unknown baseline LDL-C, an LDL-C < 100 mg per dL (2.59 mmol per L) was observed in RCTs of high-intensity statin therapy. Statin Dose Comparison. Using LDL-C targets could lead to under-treating with evidence-based statin therapy or overtreating with nonstatin drugs that have not been shown to reduce ASCVD events in RCTs. Guideline source: American College of Cardiology and American Heart Association, Guideline developed by participants without relevant financial ties to industry? High-intensity statins should be used unless contraindicated. Continuation of statin therapy is reasonable in persons who tolerate it. / If high-intensity statins are not tolerated, the maximum tolerated intensity should be used. In persons younger than 40 years or older than 75 years, potential benefits, adverse events, drug-drug interactions, and patient preferences should be considered when deciding to initiate, continue, or intensify statin therapy. 92 ( 2 ): S13 that may aid in individual risk assessment may be.. Developed by participants without relevant financial ties to industry very rarely, high-dose statin causes! 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