From the Guidelines
To effectively explain the risk of a high Framingham Risk Score (FRS) and initiate statin therapy, start with a clear, personalized conversation about cardiovascular risk, emphasizing that statins can significantly reduce this risk by lowering LDL cholesterol, as recommended by the 2018 American Heart Association/American College of Cardiology/Multisociety Cholesterol Guideline 1. When discussing the risk of high FRS with patients, it's essential to explain that the FRS estimates their 10-year risk of developing heart disease based on factors like age, cholesterol levels, blood pressure, smoking status, and diabetes. For patients with high FRS (generally >20% 10-year risk), emphasize that statins can significantly reduce this risk by lowering LDL cholesterol. The guidelines recommend moderate-intensity statin therapy for patients with a 10-year ASCVD risk of 7.5% or higher, and high-intensity statin therapy for those with a risk of 20% or higher 1. When starting treatment, consider moderate-intensity statins like atorvastatin 10-20mg daily or rosuvastatin 5-10mg daily for most patients, or high-intensity statins like atorvastatin 40-80mg or rosuvastatin 20-40mg daily for those at very high risk. Discuss potential side effects, including muscle pain, which occurs in about 5-10% of patients, and the importance of liver function monitoring. Emphasize that statins work best when combined with lifestyle modifications such as heart-healthy diet, regular exercise, smoking cessation, and weight management. Schedule follow-up in 4-12 weeks to check lipid levels and assess tolerance, adjusting the dose if needed. This approach helps patients understand both their personal risk and how statins can effectively reduce their chance of heart attack and stroke, as supported by the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults 1. Key points to consider when initiating statin therapy include:
- Patient preferences and values in shared decision making
- Potential benefits of lifestyle and statin therapies
- Potential for adverse effects and drug–drug interactions
- Consideration of costs of statin therapy
- Review of major risk factors and risk-enhancing factors.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Explaining High FRS and Starting Statin Therapy
To explain the risk of high Framingham Risk Score (FRS) and the importance of starting statin therapy to patients, consider the following points:
- High FRS indicates a higher risk of cardiovascular events, such as heart attacks and strokes 2
- Statin therapy has been shown to be a cost-effective strategy for preventing cardiovascular events in patients with high FRS (>10%) 2
- The use of statins, such as rosuvastatin, can reduce the risk of cardiovascular events by lowering low-density lipoprotein cholesterol (LDL-C) levels 2, 3
- In patients with very high cardiovascular risk, adding ezetimibe or PCSK9 inhibitors to statin therapy may further reduce the risk of non-fatal myocardial infarction (MI) and stroke 4
Benefits of Statin Therapy
The benefits of statin therapy include:
- Reduction in LDL-C levels, which can decrease the risk of cardiovascular events 2, 3, 5
- Cost-effectiveness in preventing cardiovascular events in patients with high FRS 2
- Improvement in adherence to medication when used in combination with other lipid-lowering therapies, such as ezetimibe 3
Considerations for Starting Statin Therapy
When starting statin therapy, consider the following:
- Patients with high FRS (>10%) may benefit from statin therapy, while those with lower FRS may not require treatment 2
- The use of ezetimibe or PCSK9 inhibitors may be considered in patients with very high cardiovascular risk who are not achieving treatment goals on statin therapy alone 4, 5, 6
- The cost-effectiveness of statin therapy and the potential benefits of adding other lipid-lowering therapies should be taken into account when making treatment decisions 2, 4, 5