15
Table 6. Statin Safety Recommendations (continued)
Recommendations
ACC/AHA
COR
ACC/AHA
LOE
3b. During statin therapy, it is reasonable to measure
hepatic function if symptoms suggesting hepatotoxicity
arise (e.g., unusual fatigue or weakness, loss of appetite,
abdominal pain, dark-colored urine or yellowing of the
skin or sclera).
IIa C
4. Decreasing the statin dose may be considered when
2 consecutive values of LDL-C levels are <40 mg/dL.
IIb C
5. It may be harmful to initiate simvastatin at 80 mg daily
or increase the dose of simvastatin to 80 mg daily.
III: Harm A
6. Individuals receiving statin therapy should be evaluated
for new-onset diabetes according to the current diabetes
screening guidelines. ose who develop diabetes during
statin therapy should be encouraged to adhere to a
heart-healthy dietary pattern, engage in physical activity,
achieve and maintain a healthy body weight, cease tobacco
use, and continue statin therapy to reduce their risk of
ASCVD events.
I
c
B
7. For individuals taking any dose of statins, it is reasonable
to use caution in individuals >75 years of age, as well as in
individuals who are taking concomitant medications that
alter drug metabolism, taking multiple drugs, or taking
drugs for conditions that require complex medication
regimens (e.g., those who have undergone solid organ
transplantation or are receiving treatment for HIV). A
review of the manufacturer's prescribing information may
be useful before initiating any cholesterol-lowering drug.
IIa C
