Treatment
4
Table 2. High- Moderate- and Low-Intensity Statin Therapy
(Used in the RCTs reviewed by the Expert Panel)
a
High-Intensity
Statin Therapy
Moderate-Intensity
Statin Therapy
Low-Intensity
Statin Therapy
Daily dose lowers
LDL-C on average by
approximately ≥50%
Daily dose lowers
LDL-C on average by
approximately 30%-<50%
Daily dose lowers LDL-C
on average by <30%
Atorvastatin (40
b
)-80 mg
Rosuvastatin 20 (40) mg
Atorvastatin 10 (20) mg
Rosuvastatin (5) 10 mg
Simvastatin 20-40 mg
c
Pravastatin 40 (80) mg
Lovastatin 40 mg
Fluvastatin XL 80 mg
Fluvastatin 40 mg bid
Pitavastatin 2-4 mg
Simvastatin 10 mg
Pravastatin 10-20 mg
Lovastatin 20 mg
Fluvastatin 20-40 mg
Pitavastatin 1 mg
Boldface type indicates specific statins and doses that were evaluated in RCTs. All of these RCTs
demonstrated a reduction in major cardiovascular events. Italic type indicates statins and doses that
have been approved by the FDA but were not tested in the RCTs reviewed.
a
Individual responses to statin therapy varied in the RCTs and should be expected to vary in clinical
practice. ere might be a biological basis for a less-than-average response.
b
Evidence from 1 RCT only: down-titration if unable to tolerate atorvastatin 80 mg in the IDEAL
(Incremental Decrease through Aggressive Lipid Lowering ) study.
c
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.
Table 3. Secondary Causes of Hyperlipidemia Most
Commonly Encountered in Clinical Practice
Secondary Cause Elevated LDL-C Elevated Triglycerides
Diet Saturated or trans fats,
weight gain, anorexia
Weight gain, very low-fat
diets, high intake of refined
carbohydrates, excessive alcohol
intake
Drugs Diuretics, cyclosporine,
glucocorticoids, amiodarone
Oral estrogens, glucocorticoids,
bile acid sequestrants, protease
inhibitors, retinoic acid, anabolic
steroids, sirolimus, raloxifene,
tamoxifen, beta blockers (not
carvedilol), thiazides
Diseases Biliary obstruction,
nephrotic syndrome
Nephrotic syndrome, chronic
renal failure, lipodystrophies
Disorders and
altered states of
metabolism
Hypothyroidism, obesity,
pregnancy
a
Diabetes (poorly controlled),
hypothyroidism, obesity;
pregnancy
a
a
Cholesterol and triglycerides rise progressively throughout pregnancy. Treatment with statins,
niacin, and ezetimibe are contraindicated during pregnancy and lactation.
