From the Guidelines
The 69-year-old female with a history of Supraventricular Tachycardia (SVT) on Crestor (rosuvastatin) appears to be at her therapeutic goal for lipid management, given her LDL level of 43 mg/dL, which is below the recommended threshold of 70 mg/dL for patients at high risk for ASCVD, as per the 2018 American Heart Association/American College of Cardiology/Multisociety Cholesterol Guideline 1. To assess whether she is at her therapeutic goal, we consider her current lipid panel results: LDL of 43 mg/dL, HDL of 80 mg/dL, total cholesterol of 135 mg/dL, and triglycerides of 62 mg/dL.
- Her LDL level is below 70 mg/dL, which is the recommended threshold for patients at high risk for ASCVD, such as those with established cardiovascular disease 1.
- The guideline recommends reduction of low-density lipoprotein cholesterol (LDL-C) levels with high-intensity or maximally tolerated statin therapy in patients with clinical ASCVD, and her current LDL level suggests that her rosuvastatin therapy is effective in achieving this goal 1. However, to confirm that she is at her therapeutic goal, we would need to assess her overall cardiovascular risk profile, including other comorbidities and her ASCVD risk score.
- The presence of SVT alone does not necessarily indicate high cardiovascular risk requiring aggressive lipid lowering, but her healthcare provider should review her most recent lipid panel and consider other risk factors before determining if her current rosuvastatin therapy is achieving the appropriate therapeutic goal. Given the information available, it appears that her current rosuvastatin therapy is effective in managing her lipid levels, with an LDL level of 43 mg/dL, which is below the recommended threshold of 70 mg/dL, as per the 2018 American Heart Association/American College of Cardiology/Multisociety Cholesterol Guideline 1.
From the FDA Drug Label
Rosuvastatin reduces Total-C, LDL-C, ApoB, non-HDL-C, and TG, and increases HDL-C, in adult patients with hyperlipidemia and mixed dyslipidemia
- The patient's current lipid profile is:
- Total Cholesterol: 135 mg/dL
- LDL-C: 43 mg/dL
- HDL-C: 80 mg/dL
- Triglycerides: 62 mg/dL
- The patient's goal for LDL-C is <100 mg/dL, and her current level is 43 mg/dL, which is below the goal.
- The patient's goal for Total Cholesterol is <200 mg/dL, and her current level is 135 mg/dL, which is below the goal.
- The patient is at her therapeutic goal for lipid management 2
From the Research
Lipid Management Goals
The patient's lipid profile shows:
- LDL cholesterol: 43 mg/dL (calculated)
- HDL cholesterol: 80 mg/dL
- Triglycerides: 62 mg/dL
- VLDL cholesterol: 12.4 mg/dL
Comparison to Guidelines
According to the guidelines for cardiovascular prevention, the therapeutic goal for patients with very high cardiovascular risk is to achieve an LDL-c level lower than 70 mg/dL 3. However, for patients at high risk of cardiovascular disease, the goal is to achieve an LDL cholesterol level <100 mg/dL, and optionally <70 mg/dL for very high-risk patients 4.
Patient's Status
Given the patient's history of Supraventricular Tachycardia (SVT) and current treatment with Crestor (rosuvastatin), her LDL cholesterol level is 43 mg/dL, which is below the recommended goal of <100 mg/dL and even below the optional goal of <70 mg/dL for very high-risk patients.
Key Points
- The patient's lipid profile shows that she has achieved a low LDL cholesterol level, which is consistent with the goals of lipid-lowering therapy 5, 6, 7.
- The use of rosuvastatin, a high-intensity statin, has been effective in reducing the patient's LDL cholesterol level 4.
- The addition of ezetimibe to statin therapy can further reduce LDL cholesterol levels and help patients achieve their lipid goals 5, 4.