statin potency chart
There are no recommendations for or against specific target levels for LDL-C or non–HDL-C in the primary or secondary prevention of ASCVD. Statin Dose Comparison The chart below shows statin doses expected to provide similar LDL reduction. Pharmacist's Letter includes: 12 issues every year, with brief articles about new meds and hot topics; 300+ CE courses, including the popular CE-in-the-Letter; Quick reference drug comparison charts; Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP. An algorithm for determining appropriate statin therapy for patients who are candidates for treatment is presented in eFigure A. If the increase is mild, you can continue to take the drug. All rights reserved. Related editorial: Should Family Physicians Follow the New ACC/AHA Cholesterol Treatment Guideline? All of these RCTs demonstrated a reduction in major cardiovascular events. Not Completely: Why It Is Right to Drop LDL-C Targets, but Wrong to Recommend Statins at a 7.5% 10-Year Risk, Related POEM: 2013 ACC/AHA Cholesterol Guideline Greatly Increases Number Eligible for Statin Treatment. Patient preferences should also be considered. When initiating moderate- or high-intensity statin therapy in persons older than 75 years who have clinical ASCVD, it is reasonable to evaluate for potential risk-reduction benefits, adverse effects, and drug-drug interactions. 90/No. Practice Guidelines: ACC/AHA Release Updated Guideline on the Treatment of Blood Cholesterol to Reduce ASCVD Risk. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Guideline source: American College of Cardiology and American Heart Association, Guideline developed by participants without relevant financial ties to industry? No, Published source: Circulation, June 24, 2014, Available at: http://circ.ahajournals.org/content/129/25_suppl_2/S1, Endorsed with qualifications by the AAFP, June 2014: https://www.aafp.org/patient-care/clinical-recommendations/all/cholesterol.html, MARA LAMBERT, AFP Senior Associate Editor. Statin Dose Comparison. A List of Statins – Dosing Range and Potency. All of these RCTs demonstrated a reduction in major cardiovascular events. In men and women up to 75 years of age who have clinical ASCVD, high-intensity statin therapy should be initiated unless contraindicated. When maximum intensity of statin therapy is reached, a nonstatin may be added to further reduce LDL-C levels. The Expert Panel did not find evidence to support the use of specific LDL-C or non–high-density lipoprotein cholesterol (HDL-C) target levels. Patients with primary LDL-C levels of 190 mg per dL or greater, 3. Please contact email@example.com for further information. a 31% to 40% reduction is medium intensity. This can lead to severe muscle pain and kidney damage. Although many clinicians use target levels (e.g., LDL-C levels less than 70 mg per dL for secondary prevention and less than 100 mg per dL [2.59 mmol per L] for primary prevention), evidence has shown that using the maximum tolerated statin intensity in persons who will benefit reduces ASCVD events. / afp Enlarge ||—Classes of recommendation: I = procedure or treatment should be performed or administered; IIa = it is reasonable to perform procedure or administer treatment; IIb = procedure or treatment may be considered. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR* Trial). Previous: Chest Pain with Diffuse T-Wave Inversion, Home Persons 21 years or older who have LDL-C levels of 190 mg per dL or greater should be treated with statin therapy. Please contact, ASCVD = atherosclerotic cardiovascular disease; COE = class of recommendation||; HDL-C = high-density lipoprotein cholesterol; LDL-C = low-density lipoprotein cholesterol; LOE = level of evidence, Clinical ASCVD includes acute coronary syndromes, or a history of myocardial infarction, stable or unstable angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease presumed to be of atherosclerotic origin, Estimated 10-year or “hard” ASCVD risk includes first occurrence of nonfatal myocardial infarction, coronary heart disease death, and nonfatal and fatal stroke as used by the Risk Assessment Work Group in developing the Pooled Cohort Equations (see, These factors may include primary LDL-C ≥ 160 mg per dL or other evidence of genetic hyperlipidemias; family history of premature ASCVD with onset before 55 years of age in a first-degree male relative or before 65 years of age in a first-degree female relative; high-sensitivity C-reactive protein ≥ 2 mg per L; coronary artery calcium score ≥ 300 Agatston units or ≥ 75th percentile for age, sex, and ethnicity (for additional information, see, High-risk individuals include those with clinical ASCVD, an untreated LDL-C ≥ 190 mg per dL suggesting genetic hypercholesterolemia, or diabetes, Classes of recommendation: I = procedure or treatment should be performed or administered; IIa = it is reasonable to perform procedure or administer treatment; IIb = procedure or treatment may be considered, Levels of evidence: A = multiple populations evaluated (data derived from multiple randomized clinical trials or meta-analyses); B = limited populations evaluated (data derived from a single randomized trial or nonrandomized studies); C = very limited populations evaluated (only consensus opinion of experts, case studies, or standard of care). (ACC = American College of Cardiology; AHA = American Heart Association; ASCVD = atherosclerotic cardiovascular disease; LDL-C = low-density lipoprotein cholesterol.). note: Specific statins and dosages noted in bold were evaluated in RCTs included in critical question 1, critical question 2, and the Cholesterol Treatment Trialists 2010 meta-analysis included in critical question 3 (see full guideline for details). The guideline identifies high- and moderate-intensity statin therapy for use in primary and secondary prevention (Table 1). Based on these data, the Blood Cholesterol Expert Panel from the American College of Cardiology (ACC) and the American Heart Association (AHA) issued an updated evidence-based guideline in 2013 that addresses the use of fixed doses of cholesterol-lowering drugs (statins) to reduce the risk of ASCVD in adults 21 years and older. Statins and dosages listed in italics are approved by the U.S. Food and Drug Administration but were not tested in the RCTs reviewed, LDL-C = low-density lipoprotein cholesterol; RCT = randomized controlled trial, Individual responses to statin therapy varied in the RCTs and should be expected to vary in clinical practice. Statin therapy may be considered after evaluating for potential benefits, adverse events, drug-drug interactions, and patient preferences. Endorsed with qualifications by the AAFP, June 2014, Yes: Implementing the New ACC/AHA Cholesterol Guideline Will Improve Cardiovascular Outcomes, Not Completely: Why It Is Right to Drop LDL-C Targets, but Wrong to Recommend Statins at a 7.5% 10-Year Risk, 2013 ACC/AHA Cholesterol Guideline Greatly Increases Number Eligible for Statin Treatment, http://my.americanheart.org/cvriskcalculator, http://www.cardiosource.org/science-and-quality/practice-guidelines-and-quality-standards/2013-prevention-guideline-tools.aspx, http://www.mesa-nhlbi.org/CACReference.aspx, http://circ.ahajournals.org/content/129/25_suppl_2/S1, https://www.aafp.org/patient-care/clinical-recommendations/all/cholesterol.html. Dosage adjustment may be needed based on renal function, race, or drug interactions. Before initiating statin therapy, it is reasonable for clinicians and patients to engage in a discussion about the potential for ASCVD risk-reduction benefits, adverse events, drug-drug interactions, and patient preferences. Am J Cardiol. This updated guideline focuses on reducing the risk of ASCVD in four statin benefit groups: (1) persons with clinical ASCVD (i.e., acute coronary syndromes, or a history of myocardial infarction, stable or unstable angina, coronary or other arterial revascularization, stroke, transient ischemic attack, or peripheral arterial disease of atherosclerotic origin); (2) persons with primary elevations of LDL-C levels of 190 mg per dL (4.92 mmol per L) or greater; (3) persons with diabetes mellitus who are 40 to 75 years of age with LDL-C levels of 70 to 189 mg per dL (1.81 to 4.90 mmol per L) but without clinical ASCVD; and (4) persons without clinical ASCVD or diabetes who have LDL-C levels of 70 to 189 mg per dL and an estimated 10-year ASCVD risk of 7.5% or greater.
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12th November 2018