Hyperlipidemia

Table Of Contents
1 Cholesterol Treatment Guidelines
2 Statin Intensity Criteria
3 Statin Intensity
4 Statin Side Effects

Cholesterol Treatment Guidelines

  • Atherosclerotic cardiovascular disease (acute coronary syndrome, past myocardial infarction, angina, coronary or other arterial revascularization, past stroke, TIA, or peripheral artery disease)
  • Primary elevations of LDL >190 mg/dL
  • Diabetes age 40-75 Yo and LDL 70-189
  • Without clinical ASCVD or diabetes, age 40-75, LDL 70-189, and estimated 10-year ASCVD risk of 7.5% or higher

Statin Intensity Criteria

  • Individuals with clinical ASCVD
    • Age <75: High-intensity
    • Age >75: Moderate-intensity
  • With primary elevations of LDL >190 mg/dL
    • High-intensity
  • 40-75 Yo with diabetes and LDL 70-189
    • Estimated 10-y ASCVD risk >7.5%: High-intensity
    • Estimated 10-y ASCVD risk < 7.5%: Moderate-intensity
  • Without clinical ASCVD or diabetes, age 40-75, LDL 70-189 and estimated 10-year ASCVD risk of 7.5% or higher
    • Moderate-to-high intensity

Statin Intensity

  • Moderate-intensity (30% to <50% LDL-C reduction)
    • Atorvastatin 10-20 mg
    • Rosuvastatin 5-10 mg
    • Simvastatin 20-40 mg
    • Pravastatin 40-80 mg
    • Lovastatin 40 mg
    • Fluvastatin 40 mg bid
  • High-intensity (>50% LDL-C reduction)
    • Atorvastatin 40-80 mg
    • Rosuvastatin 20 mg

Statin Side Effects

  • Myalgia (muscle complaints without CK elevations)
  • Myositis (muscle complaints with CK elevations)
  • Rhabdomyolysis (elevated CK levels, elevated creatinine)
  • Risk increased in liver or renal failure, hypothyroidism, diabetes mellitus
  • Risk increased with macrolides, azoles, cyclosporine, gemfibrozil, niacin, HIV protease inhibitors, nefazodone, verapamil, diltiazem, and amiodarone.
  • Risk increased with drinking more than a quart of grapefruit juice a day
  • Routine monitoring of CK not required.
  • Discontinue statin if CK more than 10 times upper limit of normal (ULN)