Statins Equivalent Dose
Mnemonic: PRASLPF 2-5-10-20-40-40-80
- Pituvastatin 2 mg
- Rosuvastatin 5 mg
- Atorvastatin 10 mg
- Simvastatin 20 mg
- Lovastatin 40 mg
- Pravastatin 40 mg
- Fluvastatin 80 mg
Intensity of Statins
a. High intensity (LDL lowering >/= 50%)
- Atorvastatin 40-80 mg
- Rosuvastatin 20-40 mg
b. Moderate intenstity (LDL lowering 30-49%)
- Atorvastatin 10-20 mg
- Rosuvastatin 5-10 mg
- Simvastatin 20-40 mg
- Pravastatin 40-80 mg
- Lovastatin 40-80 mg
- Fluvastatin XL 80 mg
- Fluvastatin 40 mg BD
- Pitavastatin 1-4 mg
c. Low intensity (LDL reduction <30%)
- Simvastatin 10 mg
- Pravastatin 10-20 mg
- Lovastatin 20 mg
- Fluvastatin 20-40 mg
Clinical ASCVD (Atheroscelrotic Cardiovascular Disease)
- Acute coronary syndrome (ACS)
- Myocardial infarction
- Stable or unstable angina or other arterial revascularization
- Stroke and transient ischemic attack
- Peripheral artery disease, including aortic aneurysm, all of atherosclerotic origin
ASCVD Risk
Major ASCVD events
- Recent ACS (within past 12 months)
- History of MI
- History of ischemic stroke
- Symptomatic peripheral arterial disease (claudication with ABI <0.85, or previous revascularization or amputation)
Mnemonic:
a. Ischemia: ACS, PAD, Ischemic stroke
b. Infarcton: MI
High risk condications
- Age >/= 65 years
- Heterozygous familial hypercholesterolemia
- History of prior CABG or percutaneous coronary intervention outside of the major ASCVD events
- Diabetes mellitus
- Hypertension
- CKD (eGFR 15-59 ml/min)
- Current smoking
- Persistently elevated LDL >/= 100 mg/dl despite maximally tolerated statin therapy and ezetimibe
- History of congestive heart failure
Mnemonic: 9 “C”
1. Cenior (Senior) : age 65 or more
2. Cholesterol in family
3. CABG or coronary intervention (not for major ASCVD events)
4. Carbohydrate excess (Diabetes mellitus)
5. Cuff pressure >130/80 mmHg
6. CKD
7. Cigarettes
8. Cholesterol (LDL) consistently >/= 100 mg/dl
9. Congestive heart failure
Very high risk = Multiple major ASCVD events or 1 major ASCVD event and multiple high-risk conditions.
Statin Therapy Indications
![mnemonic statin](https://epomedicine.com/wp-content/uploads/2019/08/lard.jpg)
Mnemonic: LARD
a. LDL >/= 190 mg/dl (Primary prevention)
- Age >/= 21 years: High intensity statin
b. ASCVD Clincal (Secondary prevention)
- Age </= 75 years or Very high risk ASCVD: High intensity statin
- Age >75 years: Moderate intensity statin
c. Risk of ASCVD – >7.5% in 10 years
- Moderate to high intensity statin
d. Diabetes (Primary prevention) with Age 40-75 and LDL 70-189 mg/dl
- Moderate intensity statin
- High intensity statin if ASCVD risk >7.5%
Assess adherence and percentage response to LDL-C–lowering medications and lifestyle changes with repeat lipid measurement 4 to 12 weeks after statin initiation or dose adjustment, repeated every 3 to 12 months as needed.
Target of Statin therapy
a. Primary prevention: LDL <100 mg/dl or LDL reduction by >/= 50%
b. Secondary prevention: LDL <70 mg/dl
If target not reached with maximal statins: Add Ezetimibe +/- PCSK9 Inhibitor (Alirocumab, Evolocumab)
Do not use Bile acid sequestrants when triglyceride level is >300 mg/dl.
Statins Side effects
Mnemonic: HMG CoA Reductase Inhibitor
- Hepatotoxicity
- Transaminase elevation > 3 X ULN
- Myopathy
- Myalgia (normal CK)
- Myositis (CK >ULN)
- Statin induced autoimmune myopathy (HMGCR Ab)
- GI upset
- Cataracts
- Rhabdomyolysis
- CK > 10 X ULN + Renal injury
- Increased risk of Diabetes
![dr. sulabh kumar shrestha](https://epomedicine.com/wp-content/uploads/2020/07/profile.jpg)
He is the section editor of Orthopedics in Epomedicine. He searches for and share simpler ways to make complicated medical topics simple. He also loves writing poetry, listening and playing music.