Moderate-Intensity Statin Medications
Moderate-intensity statins are defined as those that lower LDL cholesterol by 30-49%, and include atorvastatin 10-20 mg, rosuvastatin 5-10 mg, simvastatin 20-40 mg, pravastatin 40-80 mg, lovastatin 40 mg, fluvastatin XL 80 mg, and pitavastatin 1-4 mg. 1
Specific Moderate-Intensity Statin Regimens
The following medications and doses achieve the 30-49% LDL-C reduction threshold that defines moderate-intensity therapy:
- Atorvastatin 10-20 mg once daily - This is one of the most commonly prescribed moderate-intensity options 1
- Rosuvastatin 5-10 mg once daily - A potent option at the lower end of the dosing spectrum 1
- Simvastatin 20-40 mg once daily - A widely used moderate-intensity choice 1
- Pravastatin 40-80 mg once daily - Requires higher dosing to achieve moderate intensity 1
- Lovastatin 40 mg once daily - Less commonly used but effective 1
- Fluvastatin XL 80 mg once daily - Extended-release formulation 1
- Pitavastatin 1-4 mg once daily - Newer agent with moderate-intensity effects across its dosing range 1
Context for Moderate Hypertriglyceridemia and Cardiovascular Risk
For patients with moderate hypertriglyceridemia (175-499 mg/dL) and elevated cardiovascular risk, moderate-intensity statin therapy serves as the foundation of pharmacologic management 1:
- Statins provide dual benefit - They reduce LDL-C by 30-49% while simultaneously lowering triglycerides by 10-30% in a dose-dependent manner 1, 2, 3
- Primary prevention indication - For patients with diabetes aged 40-75 years without ASCVD, moderate-intensity statin therapy is recommended in addition to lifestyle modifications 1
- Risk-based approach - For patients with 10-year ASCVD risk ≥7.5%, moderate-intensity statin therapy should be initiated, and persistently elevated triglycerides ≥175 mg/dL serve as a risk-enhancing factor favoring statin initiation 1
High-Intensity Statins for Comparison
To distinguish moderate from high-intensity therapy, high-intensity statins (which lower LDL-C by ≥50%) include only 1:
- Atorvastatin 40-80 mg once daily
- Rosuvastatin 20-40 mg once daily
Clinical Application Considerations
The choice between moderate and high-intensity statin therapy depends on the patient's cardiovascular risk profile and treatment goals 1:
- Moderate-intensity therapy is appropriate for primary prevention in patients aged 40-75 years with diabetes or moderate cardiovascular risk 1
- High-intensity therapy is reserved for patients with established ASCVD, very high cardiovascular risk, or those requiring ≥50% LDL-C reduction to achieve goals <70 mg/dL 1
- For patients who cannot tolerate intended statin intensity, the maximally tolerated dose should be used 1
Triglyceride-Lowering Effects
In patients with moderate hypertriglyceridemia, statins provide meaningful but modest triglyceride reduction 2, 3:
- The triglyceride-lowering effect is proportional to baseline triglyceride levels - patients with triglycerides >250 mg/dL experience 22-45% reductions, while those with triglycerides <150 mg/dL see minimal effect 3
- The triglyceride/LDL-C reduction ratio is approximately 0.5 in patients with triglycerides 150-250 mg/dL and 1.2 in those with triglycerides >250 mg/dL 3
- If triglycerides remain >200 mg/dL after 3 months of optimized statin therapy and lifestyle modifications, additional triglyceride-lowering therapy such as icosapent ethyl or fenofibrate may be considered 1, 4