From the Guidelines
The 50-year-old female patient with an LDL cholesterol level of 150 mg/dL should be initiated on moderate-intensity statin therapy to reduce her ASCVD risk, as recommended by the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol 1. The patient's elevated LDL cholesterol level is a significant concern, despite her favorable HDL level of 57 mg/dL and low blood pressure of 90/66. According to the guideline, in adults 40 to 75 years of age without diabetes mellitus and with LDL-C levels ≥70 mg/dL, at a 10-year ASCVD risk of ≥7.5%, starting a moderate-intensity statin is recommended if a discussion of treatment options favors statin therapy 1. Key considerations for this patient include:
- Initiating moderate-intensity statin therapy, such as atorvastatin 10-20 mg daily or rosuvastatin 5-10 mg daily
- Implementing lifestyle modifications, including a heart-healthy diet low in saturated fats, regular physical activity (at least 150 minutes of moderate-intensity exercise weekly), and weight management if needed
- Assessing smoking status, as smoking significantly increases ASCVD risk
- Aiming for at least a 30-50% reduction in LDL cholesterol
- Performing follow-up lipid testing in 4-12 weeks after initiating therapy to assess response and adjust medication if needed. It is essential to have a clinician–patient risk discussion before starting statin therapy, including a review of major risk factors, the presence of risk-enhancing factors, the potential benefits of lifestyle and statin therapies, and patient preferences and values in shared decision-making 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
ASCVD Risk Factors
- The patient is a 50-year-old female with the following lipid profile:
- Cholesterol: <200 mg/dL (240 mg/dL is considered high)
- Triglycerides: <200 mg/dL (166 mg/dL)
- HDL: >=40 mg/dL (57 mg/dL)
- LDL: <100 mg/dL (150 mg/dL is considered high)
- VLDL: 2-38 mg/dL (33.2 mg/dL)
- Blood pressure: 90/66 mmHg
- Unknown smoking status
Lipid-Lowering Therapy
- According to 2, statins are effective in lowering LDL cholesterol and reducing cardiovascular risk.
- 3 suggests that combination therapy with statins and omega-3 fatty acids may be more effective in improving lipid profiles than statin monotherapy.
- 4 recommends omega-3 fatty acids for reducing triglyceride levels and cardiovascular risk.
- 5 discusses the use of PCSK9 inhibitors as an adjunct to statin therapy for reducing LDL cholesterol and cardiovascular risk.
- 6 found that adding omega-3 fatty acids to atorvastatin therapy may further improve the risk profile for coronary heart disease in patients with combined hyperlipemia.
Cardiovascular Risk Reduction
- The patient's high LDL cholesterol and triglyceride levels put her at increased risk for cardiovascular disease.
- According to 2, reducing LDL cholesterol with statin therapy can lower the risk of cardiovascular events.
- 3 and 6 suggest that combination therapy with statins and omega-3 fatty acids may provide additional cardiovascular risk reduction.
- 4 recommends omega-3 fatty acids for reducing cardiovascular risk, particularly in patients with known coronary heart disease.
- 5 discusses the use of PCSK9 inhibitors as an adjunct to statin therapy for reducing cardiovascular risk in high-risk patients.