22
Management
4.2.1.1. Statins
Table 6. High-, Moderate-, and Low-Intensity Statin Therapy*
High-Intensity
Expected % LDL-C Reduction
†
≥50%
Preferred Statins • Atorvastatin (40 mg )
80 mg
• Rosuvastatin 20 mg
(40 mg)
Other Statins —
Expected percentage LDL-C reductions with atorvastatin, rosuvastatin, and simvastatin
were estimated using the median reduction in LDL-C from the VOYAGER database.
Reductions in LDL-C for other statins (fluvastatin, lovastatin, pitavastatin, and 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 placebo-controlled
RCTs evaluating ASCVD event lowering, and the Cholesterol Treatment Trialists' 2010
meta-analysis. ese RCTs demonstrated a reduction in major ASCVD events.
Modified with permission from Grundy et al. Copyright © 2018 American Heart
Association, Inc. and American College of Cardiolog y Foundation.
* Expected percentage 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 owing to a high degree of heterogeneity seen with LDL-C–lowering medications.
†
Expected LDL-C lowering 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.
BID indicates twice daily; FDA, US Food and Drug Administration; LDL-C, low-density
lipoprotein-cholesterol; RCT, randomized controlled trial; and XL, extended release.
