14
Treatment
Table 6. Statin Safety Recommendations
Recommendations
ACC/AHA
COR
ACC/AHA
LOE
Safety
1. To maximize the safety of statins, selection of the
appropriate statin and dose in men and nonpregnant/
nonnursing women should be based on patient
characteristics, level of ASCVD
a
risk, and potential for
adverse effects.
Moderate-intensity statin therapy should be used in
individuals in whom high-intensity statin therapy
would otherwise be recommended when characteristics
predisposing them to statin-associated adverse effects are
present.
Characteristics predisposing individuals to statin adverse
effects include, but are not limited to:
• Multiple or serious comorbidities, including impaired
renal or hepatic function.
• History of previous statin intolerance or muscle disorders.
• Unexplained ALT elevations ≥3 times ULN.
• Patient characteristics or concomitant use of drugs
affecting statin metabolism.
• Age >75 years.
Additional characteristics that may modify the decision to
use higher statin intensities may include, but are not limited
to:
• History of hemorrhagic stroke.
• Asian ancestry.
I B
2a. CK should not be routinely measured in individuals
receiving statin therapy.
III: No
Benefit
A
2b. Baseline measurement of CK is reasonable for
individuals believed to be at increased risk for adverse
muscle events based on a personal or family history of
statin intolerance or muscle disease, clinical presentation,
or concomitant drug therapy that might increase the risk of
myopathy.
IIa C
2c. During statin therapy, it is reasonable to measure CK
in individuals with muscle symptoms, including pain,
tenderness, stiffness, cramping, weakness, or generalized
fatigue.
IIa C
3a. Baseline measurement of hepatic transaminase levels
(ALT) should be performed before initiaton of statin
therapy.
I
b
B
