high-intensity statin therapy
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Introduction
also see HMG CoA reductase inhibitor (statins)
Indications
- known cardiovascular disease & LDL cholesterol > 70 mg/dL[2]
- ischemic stroke in the acute post-stroke period
- transient ischemic attack
- coronary artery disease
- LDL cholesterol > 190 mg/dL
- diabetes mellitus & 10 year cardiovascular risk >= 7.5%
- some patients without diabetes mellitus & 10 year cardiovascular risk >= 7.5%[1]
Dosage
- atorvastatin 40-80 mg QD or
- rosuvastatin 20-40 mg QD[1][2][3]
- dose to achieve > 50% reduction in LDL cholesterol
- add ezetimibe as needed & then a PCSK9 inhibitor as needed
- ezetimibe 10 plus moderate intensity statin (10 mg rosuvastatin) may be alternative in patients intolerant of high intensity statin[5]
Adverse effects
- adverse effects are intensified
- patients with cardiovascular disease who took rosuvastatin vs atorvastatin had similar incidence of major cardiovascular events but higher incidence of new onset diabetes mellitus & need for cataract surgery[6]
- may increase risk of intracranial hemorrhage[8]
Drug interactions
- drug interactions are intensified
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
- ↑ 2.0 2.1 2.2 Phend C. AHA: Revised Lipid Guide Boosts PCSK9s, Coronary Calcium Scans. New recommendations aim to cut statins in low-risk primary prevention. Med Page Today. Nov 10, 2018 https://www.medpagetoday.com/meetingcoverage/aha/76250
Grundy SM, Stone NJ, Bailey AL et al 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: Executive summary J Am Coll Cardiol. 2018 Nov 3. pii: S0735-1097(18)39033-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30423391 https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000624
Grundy SM, Stone NJ, Bailey AL et al 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 Nov 8. pii: S0735-1097(18)39034-X. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30423393
Wilson PWF, Polonsky TS, Miedema MD, et al Systematic Review for the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol J Am Coll Cardiol. 2018 Nov 3. pii: S0735-1097(18)39035-1. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30423394 https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000626
Lloyd-Jones DM, Braun LT, Ndumele CE et al Use of risk assessment tools to guide decision-making in the primary prevention of atherosclerotic cardiovascular disease: A special report from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2018 Nov 3. pii: S0735-1097(18)39036-3. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30423392 - ↑ 3.0 3.1 Rodriguez F, Maron DJ, Knowles JW et al Association Between Intensity of Statin Therapy and Mortality in Patients With Atherosclerotic Cardiovascular Disease. JAMA Cardiol. Published online November 9, 2016 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27829091 Bonow RO, Yancy CW. High-Intensity Statins for Secondary Prevention. JAMA Cardiol. 2016 Nov 9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27829079
- ↑ Rodriguez F, Maron DJ, Knowles JW et al Association Between Intensity of Statin Therapy and Mortality in Patients With Atherosclerotic Cardiovascular Disease. JAMA Cardiol. Published online November 9, 2016 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27829091
Bonow RO, Yancy CW. High-Intensity Statins for Secondary Prevention. JAMA Cardiol. 2016 Nov 9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27829079 - ↑ 5.0 5.1 Lee SJ, Cha JJ, Choi WG et al Moderate-Intensity Statin With Ezetimibe Combination Therapy vs High-Intensity Statin Monotherapy in Patients at Very High Risk of Atherosclerotic Cardiovascular Disease. A Post Hoc Analysis From the RACING Randomized Clinical Trial. JAMA Cardiol. 2023;8(9):853-858 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37531130 PMCID: PMC10398545 (available on 2024-08-02) https://jamanetwork.com/journals/jamacardiology/fullarticle/2807851
- ↑ 6.0 6.1 Lee YJ et al. Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: Secondary analysis of the randomised LODESTAR trial. BMJ 2023 Oct 18; 383:e075837. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37852649 PMCID: PMC10583134 Free PMC article https://www.bmj.com/content/383/bmj-2023-075837
- ↑ Chou R, Cantor A, Dana T et al Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: A Systematic Review for the U.S. Preventive Services Task Force [Internet]. Agency for Healthcare Research and Quality (US); 2022 Aug. (Evidence Synthesis, No. 219.) Table 1, Statin Dosing and ACC/AHA Classification of Intensity. https://www.ncbi.nlm.nih.gov/books/NBK583664/table/ch1.tab1/
Grundy SM, Stone NJ, Bailey AL et al AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019 June 18;139(25):e1046-e1081 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30565953 Free article - ↑ 8.0 8.1 Fan HM, Wang YL, Zhang KL et al Intensive Versus Moderate Statin-Based Therapies in Patients With Mild Ischemic Stroke: A Prospective Multicenter Cohort Study. J Am Heart Assoc. 2024 Jul 16;13(14):e035337. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38979802 Free article. https://www.ahajournals.org/doi/full/10.1161/JAHA.124.035337