4
Diagnosis
Table 1 High-, Moderate-, and Low-Intensity Statin Therapy
a
High Intensity Moderate Intensity Low Intensity
LDL-C
lowering
b
≥50% 30%–49% <30%
Statins Atorvastatin
(40 mg
c
)
80 mg
Rosuvastatin
20 mg
(40 mg )
Atorvastatin 10 mg
(20 mg )
Rosuvastatin (5 mg )
10 mg
Simvastatin 20–40 mg
d
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
a
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.
b
LDL-C lowering that should occur with the dosage listed below each intensity.
c
Evidence from 1 RCT only: down titration if unable to tolerate atorvastatin 80 mg in the
IDEAL (Incremental Decrease through Aggressive Lipid Lowering ) study.
d
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. 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.
Boldface type indicates specific statins and doses that were evaluated in RCTs and the
Cholesterol Treatment Trialists' 2010 meta-analysis. All these RCTs demonstrated a reduction
in major cardiovascular events.
