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high-intensity statin therapy

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

Related

atorvastatin (Lipitor) HMG CoA reductase inhibitor (statin) rosuvastatin (Crestor)

General

pharmacologic therapy

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 17, 18. American College of Physicians, Philadelphia 2015, 2018.
  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: 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: 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: 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: 30423392
  3. 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: 27829091 Bonow RO, Yancy CW. High-Intensity Statins for Secondary Prevention. JAMA Cardiol. 2016 Nov 9. PMID: 27829079
  4. 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: 27829091 - Bonow RO, Yancy CW. High-Intensity Statins for Secondary Prevention. JAMA Cardiol. 2016 Nov 9. PMID: 27829079
  5. 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: 37531130 PMCID: PMC10398545 (available on 2024-08-02) https://jamanetwork.com/journals/jamacardiology/fullarticle/2807851
  6. 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: 37852649 PMCID: PMC10583134 Free PMC article https://www.bmj.com/content/383/bmj-2023-075837
  7. 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: 30565953 Free article
  8. 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: 38979802 Free article. https://www.ahajournals.org/doi/full/10.1161/JAHA.124.035337