From the FDA Drug Label
Rosuvastatin tablets are an HMG Co-A reductase inhibitor (statin) indicated: (1) To reduce the risk of major adverse cardiovascular (CV) events ... in adults without established coronary heart disease who are at increased risk of CV disease As an adjunct to diet to: reduce LDL-C in adults with primary hyperlipidemia.
The decision to prescribe a statin for a cholesterol level of 247 depends on the overall CV risk of the patient.
- If the patient has established coronary heart disease or is at increased risk of CV disease, a statin may be indicated.
- If the patient has primary hyperlipidemia, a statin may be indicated as an adjunct to diet to reduce LDL-C. However, the FDA label does not provide a specific cholesterol threshold for initiating statin therapy. Therefore, the answer to whether a cholesterol of 247 requires a statin cannot be determined based on the provided label alone 1.
From the Research
A cholesterol level of 247 mg/dL does not automatically require a statin medication, but rather a comprehensive assessment of overall cardiovascular risk, as recommended by the most recent guidelines 2. The decision to start a statin depends on multiple factors, including age, gender, blood pressure, smoking status, diabetes status, HDL ("good") cholesterol level, and family history of heart disease. These factors are used to calculate the 10-year risk of having a heart attack or stroke.
- Generally, statins are recommended when this risk is 7.5% or higher, or if you have certain conditions like diabetes or existing heart disease, as supported by the study published in the Journal of the American College of Cardiology 2.
- If a statin is recommended, common options include atorvastatin (10-80 mg daily), rosuvastatin (5-40 mg daily), or simvastatin (10-40 mg daily), which work by blocking an enzyme in the liver that produces cholesterol, thereby reducing LDL ("bad") cholesterol levels and decreasing the risk of cardiovascular events.
- Before starting medication, lifestyle modifications like diet changes, regular exercise, weight management, and smoking cessation should be attempted, as these can significantly improve cholesterol levels without medication, as discussed in the study published in the Journal of lipid and atherosclerosis 3.
- Additionally, alternative treatment options such as ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) may be considered for patients who cannot tolerate statins, as shown in the meta-analysis published in Current vascular pharmacology 4.
- The most recent study published in the Journal of the American College of Cardiology 2 demonstrates the efficacy and safety of a novel oral PCSK9 inhibitor, AZD0780, in patients with hypercholesterolemia, providing a new treatment option for those at high risk of cardiovascular events.