High-intensity statins benefit high-risk patients: Why and how to do better
Office of the Provost; Cardiology
Review of the US and European literature indicates that most patients at high risk for atherosclerotic cardiovascular disease (ASCVD are not treated with high-intensity statins, despite strong clinical-trial evidence of maximal statin benefit. High-intensity statins are recommended for 2 categories of patients: those with ASCVD (secondary prevention) and high-risk patients without clinical ASCVD. Most patients with ASCVD are candidates for high-intensity statins, with a goal for low-density lipoprotein cholesterol reduction of 50% or greater. A subgroup of patients with ASCVD are at very high risk and can benefit by the addition of nonstatin drugs (ezetimibe with or without bile acid sequestrant or bempedoic acid and/or a proprotein convertase subtilisin/kexin type 9 inhibitor). High-risk primary prevention patients are those with severe hypercholesterolemia, diabetes with associated risk factors, and patients aged 40 to 75 years with a 10-year risk for ASCVD of 20% or greater. In patients with a 10-year risk of 7.5% to less than 20%, coronary artery calcium scoring is an option; if the coronary artery calcium score is 300 or more Agatston units, the patient can be up-classified to high risk. If high-intensity statin treatment is not tolerated in high-risk patients, a reasonable approach is to combine a moderate-intensity statin with ezetimibe. In very high-risk patients, proprotein convertase subtilisin/kexin type 9 inhibitors lower low-density lipoprotein cholesterol levels substantially and hence reduce risk as well.
Mayo Clinic proceedings
Grundy, S. M.,
Stone, N. J.,
Blumenthal, R. S.,
Braun, L. T.,
Heidenreich, P. A.,
Orringer, C. E.,
Saseen, J. J.,
Smith, S. C.,
Virani, S. S.
(2021). High-intensity statins benefit high-risk patients: Why and how to do better. Mayo Clinic proceedings, 96(10), 2660-2670.
Available at: https://ecommons.aku.edu/provost_office/352
This work was published before the author joined Aga Khan University.