Expected LDL Reduction Based on Statin Dose
Statin therapy reduces LDL cholesterol by specific percentages depending on intensity, with high-intensity statins lowering LDL by ≥50%, moderate-intensity statins by 30-49%, and low-intensity statins by <30%. 1
Statin Intensity Categories and Expected LDL Reduction
High-Intensity Statins (≥50% LDL reduction)
- Atorvastatin 40-80 mg
- Rosuvastatin 20-40 mg
Moderate-Intensity Statins (30-49% LDL reduction)
- Atorvastatin 10-20 mg
- Rosuvastatin 5-10 mg
- Simvastatin 20-40 mg
- Pravastatin 40-80 mg
- Lovastatin 40 mg
- Fluvastatin XL 80 mg
- Fluvastatin 40 mg twice daily
- Pitavastatin 2-4 mg
Low-Intensity Statins (<30% LDL reduction)
- Simvastatin 10 mg
- Pravastatin 10-20 mg
- Lovastatin 20 mg
- Fluvastatin 20-40 mg
- Pitavastatin 1 mg
Specific LDL Reductions by Statin and Dose
The most recent and comprehensive guidelines from the American College of Cardiology/American Heart Association (2019) provide specific percentage reductions for different statins 1:
High-Intensity Options:
- Atorvastatin 80 mg: ≥50% reduction
- Rosuvastatin 20-40 mg: ≥50% reduction
Moderate-Intensity Options:
- Atorvastatin 10-20 mg: 30-49% reduction
- Rosuvastatin 5-10 mg: 30-49% reduction
- Simvastatin 20-40 mg: 30-49% reduction
- Pravastatin 40 mg: 30-49% reduction
Low-Intensity Options:
- Simvastatin 10 mg: <30% reduction
- Pravastatin 10-20 mg: <30% reduction
- Lovastatin 20 mg: <30% reduction
Clinical Considerations
- For every doubling of the statin dose above standard dose, an approximate additional 6% decrease in LDL-C level can be achieved 1
- Individual responses to statin therapy vary significantly, and the percentage reductions are estimates from data across large populations 1
- Some Asian populations may have a greater response to certain statins, potentially achieving higher LDL-C reductions at lower doses 1
Practical Application
When selecting statin therapy, consider:
- Baseline LDL level: Higher baseline LDL levels may require higher intensity statins to reach target goals
- Cardiovascular risk: Higher risk patients typically require greater LDL reduction
- Safety profile: High-intensity statin therapy is associated with a slightly higher rate of transaminase elevations but no hepatic failure 2
Important Caveats
- The degree of LDL-C reduction may be attributable in part to interindividual variability in response to statins, not just statin dosage 1
- Studies have demonstrated safety even with very low achieved LDL levels (<40 mg/dL), with no increase in adverse events compared to patients with higher LDL levels 3
- For patients with baseline LDL-C >190 mg/dL, high-intensity statins are typically recommended to achieve >50% reduction 1
By selecting the appropriate statin intensity based on the patient's cardiovascular risk profile and baseline LDL level, clinicians can effectively reduce morbidity and mortality from cardiovascular disease.