Should a statin (HMG-CoA reductase inhibitor) be initiated in a 35-year-old patient with hypercholesterolemia and hypertriglyceridemia?

From the Guidelines

The initiation of statin therapy in a 35-year-old patient with hypercholesterolemia and hypertriglyceridemia should be based on a comprehensive cardiovascular risk assessment, emphasizing lifestyle modifications as the first approach, and considering statin therapy only if the patient has a high-risk profile or calculated 10-year cardiovascular risk score above 7.5-10%. According to the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 1, the primary intervention for metabolic syndrome, which includes hypercholesterolemia and hypertriglyceridemia, is lifestyle therapy. Some key points to consider in this patient's management include:

• Emphasizing a heart-healthy lifestyle across the life course to reduce atherosclerotic cardiovascular disease (ASCVD) risk at all ages 1
• Assessing lifetime risk to facilitate the clinician–patient risk discussion and emphasizing intensive lifestyle efforts in young adults 20 to 39 years of age 1
• Considering statin therapy in patients with severe primary hypercholesterolemia (LDL-C level ‡190 mg/dL [‡4.9 mmol/L]) or in those with a calculated 10-year ASCVD risk of ‡7.5% 1
• Starting with moderate-intensity statin therapy in patients 40 to 75 years of age with diabetes mellitus and LDL-C ‡70 mg/dL (‡1.8 mmol/L), or in those without diabetes mellitus and with LDL-C levels ‡70 mg/dL (‡1.8 mmol/L) at a 10-year ASCVD risk of ‡7.5% 1 Given the patient's age and the absence of other high-risk factors, lifestyle modifications should be the initial approach, with statin therapy considered only if the patient's risk profile warrants it, as determined by a comprehensive cardiovascular risk assessment. Regular monitoring with lipid panels and liver function tests is necessary, with follow-up 4-12 weeks after starting therapy, if a statin is initiated. Treatment decisions should be made collaboratively, considering the patient's preferences and overall health status.

From the FDA Drug Label

Rosuvastatin tablets are an HMG Co-A reductase inhibitor (statin) indicated: ... As an adjunct to diet to: reduce LDL-C in adults with primary hyperlipidemia. ... As an adjunct to diet for the treatment of adults with: Hypertriglyceridemia. The patient is 35 years old and has hypercholesterolemia and hypertriglyceridemia.

• The drug label indicates that rosuvastatin is used to reduce LDL-C in adults with primary hyperlipidemia and to treat hypertriglyceridemia in adults.
• Since the patient has hypercholesterolemia and hypertriglyceridemia, a statin like rosuvastatin can be considered as an adjunct to diet.
• The patient's age is 35, which is within the adult range, so the indication applies. The FDA label supports the use of a statin in this patient, so yes, a statin (HMG-CoA reductase inhibitor) can be initiated in a 35-year-old patient with hypercholesterolemia and hypertriglyceridemia 2.

From the Research

Statin Initiation in a 35-year-old Patient with Hypercholesterolemia and Hypertriglyceridemia

• The decision to initiate a statin in a 35-year-old patient with hypercholesterolemia and hypertriglyceridemia depends on various factors, including the patient's cardiovascular risk profile and the severity of their lipid abnormalities 3.
• According to the study published in the American Family Physician, management of high triglyceride levels starts with dietary changes and physical activity to lower cardiovascular risk 3.
• Statins can be considered for patients with high triglyceride levels who have borderline or intermediate risk, as they have been shown to reduce mean triglyceride levels by up to 18% 4.
• The study published in the Journal of Lifestyle Medicine suggests that lifestyle modifications, including changes in diet, exercise, and reduction in body mass index, can be effective in reducing triglyceride levels 5.
• Additionally, the study published in Atherosclerosis recommends the use of statins as the first line of therapy for the management of mild to moderate hypertriglyceridemia, with the addition of fibrates, niacin, or long-chain omega-3 fatty acids if elevated triglyceride or non-high-density lipoprotein cholesterol levels persist despite the use of high-intensity statin therapy 4.
• The combination of rosuvastatin and ezetimibe has been shown to be safe and effective in patients with hypercholesterolemia or dyslipidemia, enabling higher proportions of patients to achieve recommended LDL-C goals without additional adverse events 6.
• The study published in the Journal of Lipid Research found that the combination of rosuvastatin, ezetimibe, and PCSK9 inhibition led to greater reductions in serum non-HDL and triglyceride levels 7.