28
Diagnosis
6. Implementation
6. Implementation
COR LOE
Recommendations
I A 1. Interventions focused on improving adherence to prescribed
therapy are recommended for management of adults with elevated
cholesterol levels, including telephone reminders, calendar
reminders, integrated multidisciplinary educational activities, and
pharmacist-led interventions, such as simplification of the drug
regimen to once-daily dosing.
I B-NR 2. Clinicians, health systems, and health plans should identify
patients who are not receiving guideline-directed medical therapy
and should facilitate the initiation of appropriate guideline-
directed medical therapy, using multifaceted strategies to improve
guideline implementation.
I B-NR 3. Before therapy is prescribed, a patient-clinician discussion should
take place to promote shared decision-making and should include
the potential for ASCVD risk-reduction benefit, adverse effects,
drug-drug interactions, and patient preferences.
Table 9. Statin-Associated Side Effects (SASE)
Statin-Associated
Side Effects Frequency
Predisposing
Factors
Quality of
Evidence
Central nervous system
Memory/cognition Rare/unclear Case reports;
no increase
in memory/
cognition
problems in 3
large-scale
RCTs
Cancer No definite
association
RCTs/meta-
analyses
Other
Renal function Unclear/unfounded
Cataracts Unclear
Tendon rupture Unclear/unfounded
Hemorrhagic stroke Unclear
Interstitial lung disease Unclear/unfounded
Low testosterone Unclear/unfounded
