From the Guidelines
Statin therapy should be initiated in patients with a 10-year risk of cardiovascular disease exceeding 7.5%, as recommended by the 2018 American Heart Association/American College of Cardiology/Multisociety cholesterol guideline 1. For primary prevention in patients with elevated risk, start with moderate-intensity statins such as atorvastatin 10-20 mg daily, rosuvastatin 5-10 mg daily, or simvastatin 20-40 mg daily. The decision to initiate statin therapy should be based on a comprehensive assessment of the patient's risk factors, including the Framingham Risk Score, as well as other risk-enhancing factors such as family history of premature ASCVD, persistently elevated LDL-C levels, and chronic kidney disease 1. Before initiating therapy, obtain baseline lipid panels and liver function tests, then repeat these tests 4-12 weeks after starting treatment to assess response and tolerability. Lifestyle modifications including diet changes, exercise, and smoking cessation should accompany statin therapy. The use of coronary artery calcium (CAC) score as a risk modifier can also guide statin therapy, particularly in patients with intermediate or borderline risk 1. In patients with very high-risk ASCVD, the goal is to reduce LDL-C levels by at least 50% 1. Overall, the initiation of statin therapy should be individualized based on the patient's risk profile and clinical judgment, with the goal of reducing cardiovascular morbidity and mortality.
Key points to consider:
- The 2018 American Heart Association/American College of Cardiology/Multisociety cholesterol guideline recommends statin therapy for patients with a 10-year risk of cardiovascular disease exceeding 7.5% 1.
- Moderate-intensity statins are recommended for primary prevention in patients with elevated risk, while higher intensity statins are recommended for secondary prevention in patients with established cardiovascular disease.
- The decision to initiate statin therapy should be based on a comprehensive assessment of the patient's risk factors, including the Framingham Risk Score and other risk-enhancing factors.
- Lifestyle modifications, including diet changes, exercise, and smoking cessation, should accompany statin therapy.
- The use of CAC score as a risk modifier can guide statin therapy, particularly in patients with intermediate or borderline risk.
From the Research
Initiating Statin Therapy Based on Framingham Risk Score
- The Framingham Risk Score is used to estimate the 10-year cardiovascular risk of an individual based on factors such as age, sex, smoking, total cholesterol, high-density lipoprotein-cholesterol, blood pressure, and diabetes 2.
- Studies have shown that statin therapy can be effective in reducing low-density lipoprotein cholesterol (LDL-C) levels and preventing cardiovascular events 3, 4, 5, 6.
- The decision to initiate statin therapy based on the Framingham Risk Score should consider the individual's overall cardiovascular risk profile, as well as their LDL-C levels and other risk factors.
- For individuals with high cardiovascular risk, statin therapy may be recommended, and the choice of statin and dosage should be based on the individual's specific needs and medical history 3, 4.
- In some cases, combination therapy with ezetimibe or other lipid-lowering agents may be necessary to achieve optimal LDL-C levels 4, 5, 6.
- The Framingham Risk Score has also been associated with cognitive function in older adults, with higher risk scores linked to lower cognitive performance 2.
- It is essential to consider the individual's overall health profile and medical history when making decisions about statin therapy and cardiovascular risk management.