From the Guidelines
For individuals with an ASCVD risk score over 10%, high-intensity statin therapy is recommended to reduce LDL-C levels by an average of at least 50%. This is based on the 2018 American Heart Association/American College of Cardiology/Multisociety Cholesterol Guideline, which suggests that high-intensity statin therapy is necessary for patients at high risk for ASCVD 1. The guideline recommends using medications such as atorvastatin 40-80 mg daily or rosuvastatin 20-40 mg daily to achieve this goal. Some key points to consider when implementing high-intensity statin therapy include:
- Regular monitoring with lipid panels and liver function tests is necessary, typically at 4-12 weeks after initiation and then annually.
- In patients who have a baseline LDL-C level of approximately 1.8 mmol/L (70 mg/dL) and are receiving statin therapy, addition of ezetimibe can reduce risk for major events by 2 percentage points 1.
- For patients at very high risk whose LDL-C levels remain above 1.8 mmol/L (70 mg/dL) while receiving maximally tolerated statin and ezetimibe therapy, a PCSK9 inhibitor is a reasonable addition, although long-term safety and cost-effectiveness should be considered 1. It is essential to note that the specific intensity and type of statin therapy may vary depending on individual risk factors and patient characteristics, and should be determined on a case-by-case basis.
From the Research
Medication Dosage for ASCVD Risk Score Over 10
- The recommended medication dosage for a ASCVD risk score over 10 is not explicitly stated in the provided studies.
- However, according to the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines, as mentioned in 2, very high-risk ASCVD patients who are not achieving treatment goals on a maximum tolerated dose of a statin and ezetimibe may be considered for PCSK9 inhibitors.
- The use of statins remains the first-line therapy for primary and secondary prevention of ASCVD, as stated in 3.
- For patients at high risk of ASCVD, lifestyle management and pharmacologic therapy are recommended, as mentioned in 4.
- The studies suggest that the treatment approach should be individualized based on the patient's risk factors, medical history, and response to treatment.
- The clinician-patient risk discussion focusing on lifestyle management and the risks and benefits of evidence-based pharmacologic therapies is central to the treatment process, as stated in 4.