Title
High-intensity statins benefit high-risk patients: Why and how to do better
Document Type
Article
Department
Office of the Provost; Cardiology
Abstract
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.
Publication ( Name of Journal)
Mayo Clinic proceedings
Recommended Citation
Grundy, S. M.,
Stone, N. J.,
Blumenthal, R. S.,
Braun, L. T.,
Heidenreich, P. A.,
Lloyd-Jones, D.,
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
Comments
This work was published before the author joined Aga Khan University.