Decision to Treat
When elevated lipids are discovered by lipid panel blood tests, evidence clearly shows that lowering them reduces the risk of cardiovascular disease (CVD) and CVD-related events:
- Coronary artery disease: Including myocardial infarction (MI), angina, or heart failure
- Cerebrovascular disease: Presenting as stroke or TIA
- Peripheral artery disease: Suspected with claudication (pain of muscles with exertion) or limb ischemia
- Aortic atherosclerosis: Such as thoracic or abdominal aortic aneurysm
Treatment for abnormal lipid levels is based on the computed risk of suffering a CVD event within 10 years, predicted by a what is called a CVD Risk Calculator. There are many versions of CVD calculators, but they generally all use lipid levels along with other comorbidities, such as diabetes, hypertension, smoking, family history, kidney disease, and obesity.
Treatment with Statins
Statins, taken daily, usually in the evening, are the most powerful drugs for lowering LDL-C. Different statins may also impact the other cholesterol and triglyceride values favorably, although the target is LDL-C.
One of the moderate-intensity statins is used initially:
- Lovostatin (Mevacor, Altoprev), 40 mg
- Pravastatin (Pravachol), 40 mg
- Simvastatin (Zocor), 40 mg
- Atorvastatin (Lipitor), 10 to 20 mg
- Rosuvastatin (Crestor), 5 to 10 mg
When those fail, higher-intensity statins are considered:
- Atorvastatin (Lipitor), 40 to 80 mg
- Rosuvastatin (Crestor), 20 to 40 mg
Current guidelines recommend that any adults aged 40-75 without CVD but with an LDL-C between 70-189 mg/dL should be treated:
- Treatment with moderate-intensity statin therapy is recommend for those with an estimated 10-year CVD risk between 5.0-7.5%
- Those with an estimated 10-year CVD risk ≥7.5% are treated with moderate-to-high intensity statin therapy
For patients at high risk, the LDL-C should be lowered to <100 mg/dL, or at least 50% of the original baseline level. For very high-risk patients, LDL-C should be lowered to <70 mg/dL, or a reduction of at least 50% of the original baseline levels.
Any prescribed statin protocol requires periodic re-assessments, measuring LDL-C response to the prescribed statins at the 6-week mark, followed by lipid panels yearly. During these times interval checks on blood pressure, signs and symptoms of atherosclerotic disease, glucose and hemoglobin A1c levels, weight, and liver/kidney function can be made.