Statin treatment regimens

Statins are first-line lipid-modifying therapy for the reduction of atherosclerotic cardiovascular disease (ASCVD) risk, and should be started in all patients with established ASCVD and those who are at high ASCVD risk. The efficacy of statins in reducing the risk of both primary and secondary cardiovascular events is proven, and there is a low rate of serious adverse effects with long-term use.

All statins reduce ASCVD risk. The extent of the benefit depends on the extent of low-density lipoprotein cholesterol (LDL-C) reduction achieved, which in turn depends on both the dose and potency of the statin used. A higher dose of a statin produces a greater percentage reduction in LDL-C. Atorvastatin, rosuvastatin and, to a lesser extent, simvastatin, are considered high-potency statins, as they have a greater capacity to reduce LDL-C. High-intensity statin therapy refers to the use of a high dose of a high-potency statin.

For secondary prevention of cardiovascular events, start high-intensity statin therapy. High-intensity therapy, compared with moderate-intensity statin therapy, achieves a greater reduction in the incidence of secondary cardiovascular events and cardiovascular death following an acute coronary syndrome.

For primary prevention of ASCVD, consider starting therapy with a high-intensity statin if the patient is at high or very high ASCVD risk, or their LDL-C is significantly elevated. High-intensity statins should also be used if follow-up and further uptitration is unlikely to occur. Starting at a lower dose and increasing the dose slowly is better tolerated in some patients.

If high-intensity statin therapy is considered appropriate, use:

If high-intensity statin therapy is not required, consider starting with a low or medium dose and titrating to achieve the target lipid concentrations. Appropriate dose ranges of statins are: