28
Treatment
Table 11. High-, Moderate-, and Low-Intensity Statin
Therapy*
High Intensity Moderate Intensity Low Intensity
LDL-C
Lowering
†
≥50% 30% – 49% <30%
Statins
Atorvastatin (40 mg
‡
),
80 mg
Rosuvastatin 20 mg
(40 mg )
Atorvastatin 10 mg
(20 mg )
Rosuvastatin (5 mg )
10 mg
Simvastatin 20–40 mg
§
Simvastatin 10 mg
Pravastatin 40 mg
(80 mg )
Lovastatin 40 mg
(80 mg )
Fluvastatin XL 80 mg
Fluvastatin 40 mg BID
Pitavastatin 1–4 mg
Pravastatin 10–20 mg
Lovastatin 20 mg
Fluvastatin 20–40 mg
Percent LDL-C reductions with the primary statin medications used in clinical
practice (atorvastatin, rosuvastatin, simvastatin) were estimated using the median
reduction in LDL-C from the VOYAGER database. Reductions in LDL-C for other
statin medications (fluvastatin, lovastatin, pitavastatin, pravastatin) were identified
according to FDA-approved product labeling in adults with hyperlipidemia, primary
hypercholesterolemia, and mixed dyslipidemia. https://www.accessdata.fda.gov/scripts/
cder/daf/ Accessed January 8, 2021.
Boldface type indicates specific statins and doses that were evaluated in RCTs and
the Cholesterol Treatment Trialists' 2010 meta-analysis. ese RCTs demonstrated a
reduction in major cardiovascular events.
* Percent reductions are estimates from data across large populations. Individual responses to
statin therapy varied in the RCTs and should be expected to vary in clinical practice.
†
LDL-C lowering that should occur with the dosage listed below each intensity.
‡
Evidence from 1 RCT only: down titration if unable to tolerate atorvastatin 80 mg in the
IDEAL (Incremental Decrease through Aggressive Lipid Lowering ) study.
§
Although simvastatin 80 mg was evaluated in RCTs, initiation of simvastatin 80 mg
or titration to 80 mg is not recommended by the FDA because of the increased risk of
myopathy, including rhabdomyolysis.
Reprinted with permission from Grundy SM, et al. op. cit. Copyright 2019 American Heart
Association, Inc. and American College of Cardiolog y Foundation.
