Hyperlipidemia PocketGuide

Last Updated: February 16, 2021
Downloadable PDF: Here

Statin Classification by Expected LDL-C Reduction (2018 ACC/AHA/et al Guideline)

High Intensity Therapy aModerate Intensity Therapy bLow Intensity Therapy c
Atorvastatin 40-80mg
Rosuvastatin 20-40mg
Atorvastatin 10-20mg
Rosuvastatin 5-10mg
Simvastatin 20-40mg
Pravastatin 40-80mg
Lovastatin 40mg
Fluvastatin XL 80mg
Fluvastatin 40 mg BID
Pitavastatin 1-4mg
Simvastatin 10mg
Pravastatin 10-20mg
Lovastatin 20mg
Fluvastatin 20-40mg
a Expected LDL reduction > 50%
b Expected LDL reduction > 30% to 50%
c Expected LDL reduction < 30%
  • Major ASCVD Events: recent ACS (within past 12 months), history of MI, history of ischemic stroke, symptomatic peripheral arterial disease (history of claudication with ABI <0.85 or previous revascularization or amputation)
  • High Risk Conditions: age >65 y, heterozygous familial hypercholesterolemia, history of prior coronary artery bypass surgery or percutaneous coronary intervention outside of the major ASCVD event(s), diabetes mellitus, hypertension, CKD (eGFR 15-59 ml/min/1.73m2), current smoking, persistently elevated LDL-C (>100 mg/dl despite maximally tolerated statin therapy and ezetimibe), history of congestive heart failure

Clinical Pearls

  • Statin adverse drug reactions: myotoxicity/myalgia/mytosis (muscle pain with elevated creatine kinase [CK]) that can rarely lead of rhabdomyolysis. When a statin is suspected, temporary hold is recommended for 2 weeks. If it doesn’t resolve, statin is not likely to be the cause and should be reinitiated at original dose. 
  • Common drug-drug interactions: fibrates (gemfibrozil contraindicated with simvastatin), amiodarone (maximum doses with lovastatin 40mg, simvastatin 20mg), CCBs


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