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Cholesterol

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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.

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