Cholesterol – initiating statin

Start screening at 35 years old (or if pt is “high risk:” family Hx of CAD). Repeat every 5 years.

Order both:

  • 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.

  1. 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.
  2. 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:

Indication Recommended 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:

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.


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