What is considered a high-intensity statin (HMG-CoA reductase inhibitor)?

From the Guidelines

High intensity statins are medications that reduce LDL cholesterol by 50% or more from baseline levels, and according to the most recent guidelines, these include atorvastatin at doses of 40-80 mg daily and rosuvastatin at doses of 20-40 mg daily 1.

Key Characteristics of High Intensity Statins

• Reduce LDL cholesterol by 50% or more from baseline levels
• Include atorvastatin at doses of 40-80 mg daily and rosuvastatin at doses of 20-40 mg daily
• Typically prescribed for patients with established atherosclerotic cardiovascular disease, those with very high LDL cholesterol levels (190 mg/dL or higher), or patients with diabetes plus multiple cardiovascular risk factors ### Mechanism of Action and Side Effects
• Work by inhibiting HMG-CoA reductase, an enzyme crucial for cholesterol production in the liver, thereby significantly reducing cholesterol synthesis
• May cause side effects including muscle pain, liver enzyme elevations, and slightly increased risk of diabetes
• Regular monitoring of liver function and muscle symptoms is recommended when taking these medications ### Clinical Use and Recommendations
• High intensity statins are recommended for patients who require significant reduction in LDL cholesterol to reduce the risk of cardiovascular events
• The choice of statin and dose should be individualized based on the patient's risk factors, medical history, and potential for adverse effects
• Patients should be monitored regularly for side effects and adjustments made to their treatment plan as needed 2, 3.

From the FDA Drug Label

For patients that require a high-intensity statin or are unable to achieve their LDL-C goal receiving pravastatin sodium tablets 80 mg daily, prescribe alternative LDL-C-lowering treatment The FDA drug label does not answer the question.

From the Research

Definition of High-Intensity Statins

High-intensity statins are defined as those that can reduce low-density lipoprotein cholesterol (LDL-C) by 50% or more 4, 5.

Examples of High-Intensity Statins

Examples of high-intensity statins include:

• Rosuvastatin 20-40 mg 4, 6, 7
• Atorvastatin 40-80 mg 4, 5, 6, 8

Comparison of High-Intensity Statins

Studies have compared the effects of different high-intensity statins on LDL-C reduction, including:

• Rosuvastatin vs. atorvastatin: Rosuvastatin 20 and 40 mg were found to be more effective than atorvastatin 40 mg in reducing LDL-C 4
• Atorvastatin vs. other statins: Atorvastatin was found to be more effective than fluvastatin, lovastatin, and pravastatin in reducing LDL-C, but less effective than simvastatin 8
• Rosuvastatin vs. simvastatin and pravastatin: Rosuvastatin 10 mg was found to be more effective than simvastatin 20 mg and pravastatin 20 mg in achieving LDL-C goals 7

Patient Groups Benefiting from High-Intensity Statins

High-intensity statins are recommended for patient groups with:

• Atherosclerotic cardiovascular disease (ASCVD) 4, 5
• LDL-C ≥190 mg/dl 4
• Diabetes 4
• A 10-year ASCVD risk ≥7.5% 4
• Severe hypercholesterolemia, diabetes with associated risk factors, and patients aged 40 to 75 years with a 10-year risk for ASCVD of 20% or greater 5