Based on: 2018 AHA/ACC/ACCVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guidelines
Last Updated: February 16, 2021
Downloadable PDF: Here
Statin Classification by Expected LDL-C Reduction (2018 ACC/AHA/et al Guideline)
| High Intensity Therapy a | Moderate Intensity Therapy b | Low 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 |
b Expected LDL reduction > 30% to 50%
c Expected LDL reduction < 30%
- For your reference: 10 year ASCVD Risk Calculator
- 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
References