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Statin Therapy for Patients with Cardiovascular Disease

SCAN_5Star_StatinTherapyPatientsCardioDisease_Fig01

 

Exclusions

  • Cirrhosis
  • Clomiphene use
  • ESRD
  • Hospice
  • In vitro fertilization
  • Myalgia, myositis, myopathy or rhabdomyolysis
  • Pregnancy

Important guidelines for your practice

The ACC/AHA guideline emphasizes that lifestyle modification remains a critical component of ASCVD reduction.1,2

Statin therapy is recommended in the following four groups:3

  • Patients with any form of clinical ASCVD
  • Patients with primary LDL-C levels of 190mg per dL or greater
  • Patients with diabetes mellitus, 40 to 75 years of age, with LDL-C levels of 70 to 189mg per dL
  • Patients without diabetes, 40 to 75 years of age, with an estimated 10-year ASCVD risk of at least 7.5 percent

The guideline recommends reducing ASCVD risk with the maximum tolerated statin intensity rather than achieving a specific LDL-C target. Statin intensity depends on the percent change in LDL-C from baseline rather than absolute LDL-C reduction.

Risk assessment for 10-year and lifetime risk is recommended using an updated ASCVD risk calculator (http://my.americanheart.org/cvriskcalculator).

Recommendations resulted from expert panel reviews of evidence including:

  • In adults with coronary heart disease, statin therapy reduced the relative risk for cardiovascular events by 21 percent per 38.7mg/dL LDL-C reduction.1
  • In adults with and without cardiovascular disease who received more intensive statin therapy or statin therapy compared with placebo, the risk for cardiovascular disease mortality was reduced by 14 percent per 38.7mg/dL LDL-C reduction.4

High-intensity statins are recommended for patients with clinical ASCVD. As some patients may experience statin-associated side effects, SPC permits moderate-intensity statins. 

1ACC/AHA Release Updated Guideline on the Treatment of Blood Cholesterol to Reduce ASCVD Risk, Am Fam Physician. 2014 Aug 15;90(4):260-265

2Also see to the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, Stone NJ, et. al., Circulation, November 12, 2013.

3See section 4, Statin Treatment Recommendations in the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults for a discussion of individual treatment options.

4Cholesterol Treatment Trialists’ Collaboration, Baigent C, Blackwell L. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomized trials. Lancet 2010;376:1670–81

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