12
Treatment
Figure 4. Statin Therapy:
Monitoring therapeutic response and adherence
Assess medication and
lifestyle adherence
Fasting lipid panel
a
Anticipated
therapeutic
response?
Indicators of anticipated therapeutic
response and adherence to selected
statin intensity:
• High-intensity statin therapy
b
reduces LDL-C approx. ≥50%
from the untreated baseline.
• Moderate-intensity statin therapy
reduces LDL-C ~30% to <50%
from the untreated baseline.
YES NO
Reinforce continued
adherence
Follow-up 3-12 mo
Less-than-anticipated
therapeutic response
Intolerance to
recommended dose of
statin therapy?
NO
Reinforce medication adherence
Reinforce adherence to intensive
lifestyle changes
Exclude secondary causes of
hypercholesterolemia
Follow-up 4-12 wk
Management of
statin intolerance
(Table 6)
YES
Anticipated
therapeutic
response?
NO
Reinforce improved
adherence
Increase statin intensity
OR
Consider addition of
nonstatin drug therapy
Follow-up 4-12 wk &
thereaer as indicated
Colors correspond to the Classes of Recommendations in the ACC/AHA Table (Pages 18-19).
a
Fasting lipid panel preferred. In a nonfasting individual, a nonfasting non-HDL-C ≥220 mg/dL
may indicate genetic hypercholesterolemia that requires further evaluation or a secondary etiolog y.
If nonfasting triglycerides are ≥500 mg/dL, a fasting lipid panel is required.
b
In those already on a statin, in whom baseline LDL-C is unknown, an LDL-C <100 mg/dL was
observed in most individuals receiving high-intensity statin therapy in RCTs.
YES
