29
5.2. Lipid-Lowering Therapy for PAD
COR LOE
Recommendations
1 A
1. In patients with PAD, treatment with high-intensity statin
therapy is indicated, with an aim of achieving a ≥50% reduction
in low-density lipoprotein cholesterol (LDL-C) level.
2a B-R
2. In patients with PAD who are on maximally tolerated
statin therapy and have an LDL-C level of ≥70 mg/dL, it is
reasonable to add PCSK9 inhibitor therapy.
2a B-R
3. In patients with PAD who are on maximally tolerated
statin therapy and have an LDL-C level of ≥70 mg/dL, it is
reasonable to add ezetimibe therapy.
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 mg–40 mg
‡
Pravastatin
40 mg–80 mg
Lovastatin
40 mg–80 mg
Fluvastatin XL
80 mg
Fluvastatin
40 mg twice daily
Pitavastatin
1 mg–4 mg
Simvastatin
10 mg
Pravastatin
10 mg–20 mg
Lovastatin
20 mg
Fluvastatin
20 mg–40 mg
Percent LDL-C reductions with the 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 dyslipidemia, primary hypercholesterolemia, and mixed dyslipidemia.
* 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.
‡
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.
Modified with permission from Grundy, et al. Copyright © 2018 American Heart
Association, Inc., and American College of Cardiolog y Foundation.
