Start screening at 35 years old (or if pt is “high risk:” family Hx of CAD). Repeat every 5 years.
- Lipid Panel
- CMP – assess baseline LFTs
- Recheck: 6 weeks – 3 months if recently changed Statin med
- Recheck: 1 time per year if maintenance, no new changes made.
First: Recommend lifestyle modifications such as exercising regularly, eating a healthy diet, and maintaining a healthy weight.
- Lifestyle modifications to lower cardiovascular disease risk: This includes eating a heart-healthy diet, regular aerobic exercises, maintenance of desirable body weight, and avoidance of tobacco products.
- If patient is reluctant about starting a statin, suggest fish oil: 1,200mg PO – Take 2 capsules in the morning and 1 capsule in the evening.
Guidelines for lipid-lowering therapy:
|Clinically significant atherosclerotic disease:
· ACS, MI
· Stable or unstable angina
· Coronary or other arterial revascularization
· CVA, TIA, PAD
|Age ≤ 75: High-intensity statin
Age > 75: Moderate-intensity statin
|Age ≥ 21, LDL ≥ 190mg/dL||High-intensity statin|
|Age 40-75 with diabetes||10-year ASCVD risk ≥ 7.5%: High-intensity statin
10-year ASCVD risk < 7.5%: Moderate-intensity statin
|LDL 70-189 mg/dL, estimated 10-year ASCVD risk ≥ 7.5%||Moderate-to-high-intensity statin|
High-intensity statin: Atorvastatin 40-80mg qd or Rosuvastatin (Crestor) 20-40mg qd
Moderate-intensity statin: Atorvastatin 10-20mg qd, Rosuvastatin 5-10mg qd, Simvastatin 20-40mg qd, Pravastatin 40-80mg qd, or Lovastatin 40mg qd
Calculate ASCVD: http://tools.acc.org/ASCVD-Risk-Estimator/
If myalgias is present:
- Check Vitamin D level (if deficient, more myalgias).
- Switch to more hydrophilic: Rosuvastatin (Crestor), Pravastatin
- Give with CoQ-10.
- Avoid Simvastatin 80mg – most likely to cause myalgia. Do not use on anyone.