Therapeutic response to statin therapy

Template:Hypercholesterolemia Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Monitoring Statin Therapy

Class I

"1. Adherence to medication and lifestyle, therapeutic response to statin therapy, and safety should be regularly assessed. This should also include a fasting lipid panel performed within 4 to 12 weeks after initiation or dose adjustment, and every 3 to 12 months thereafter. Other safety measurements should be measured as clinically indicated. (Level of Evidence: A)"

Optimizing Statin Therapy

Class I*

"1. The maximum tolerated intensity of statin should be used in individuals for whom a high- or moderate-intensity statin is recommended, but not tolerated. (Level of Evidence: B)"

^{"*Several RCTs found that low and low-moderate intensity statin therapy reduced ASCVD events. In addition, the CTT meta-analyses found each 39 mg/dL reduction in LDL–C reduces ASCVD risk by 22%. Therefore, the Panel considered that submaximal statin therapy should be used to reduce ASCVD risk in those unable to tolerate moderate-or high-intensity statin therapy."}

Insufficient Response to Statin Therapy

Class I

"1. In individuals who have a less-than-anticipated therapeutic response or are intolerant of the recommended intensity of statin therapy, the following should be performed: Reinforce medication adherence Reinforce adherence to intensive lifestyle changes Exclude secondary causes of hyperlipidemia(Level of Evidence: A)"

Class IIa

"1. It is reasonable to use the following as indicators of anticipated therapeutic response to the recommended intensity of statin therapy. Focus is on the intensity of the statin therapy. As an aid to monitoring: High-intensity statin therapy† generally results in an average LDL–C reduction of ≥50% from the untreated baseline. Moderate-intensity statin therapy generally results in an average LDL–C reduction of 30 to <50% from the untreated baseline. LDL–C levels and percent reduction are to be used only to assess response to therapy and adherence. They are not to be used as performance standards.(Level of Evidence: B)"

"2. In individuals who are candidates for statin treatment but are completely statin intolerant, it is reasonable to use nonstatin cholesterol-lowering drugs that have been shown to reduce ASCVD events in RCTs if the ASCVD risk-reduction benefits outweigh the potential for adverse effects.(Level of Evidence: B)"

Class IIb

"1. In individuals at higher ASCVD risk receiving the maximum tolerated intensity of statin therapy who continue to have a less-than-anticipated therapeutic response, addition of a non-statin cholesterol-lowering drug(s) may be considered if the ASCVD risk-reduction benefits outweigh the potential for adverse effects. Higher-risk individuals include: Individuals with clinical ASCVD‡ <75 years of age Individuals with baseline LDL–C ≥190 mg/dL. Individuals 40 to 75 years of age with diabetes mellitus. Preference should be given to non-statin cholesterol-lowering drugs shown to reduce ASCVD events in RCTs.(Level of Evidence: C)"

^{"†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.
‡Clinical ASCVD includes acute coronary syndromes, or a history of MI, stable or unstable angina, coronary or other arterial revascularization, stroke, TIA, or peripheral arterial disease presumed to be of atherosclerotic origin."}

References

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