Moderate and High Intensity Statins; RASP

StatinNameModerate IntensityHigh Intensity [=4XModerate intensity]
RRosuvastatin5-10 mg20-40 mg
AAtorvastatin10-20 mg40-80 mg
SSimvastatin20-40 mg
PPravastatin or
Lovastatin
40-80 mg

Dose doubles each step we go down in the table.

High intensity dose is 4 times the moderate intensity dose.

For patients with an LDL-C >100 mg/dL (2.6 mmol/L) and a greater than 10 percent risk of a CVD event within 10 years, UpToDate recommends statin therapy.

In primary prevention, when the decision is made to treat, UpToDate suggests treatment with a moderate dose of a statin.

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High Intensity dose for following conditions:

ASCVD like PAD, CAD, TIA, CVA only if <75 yr old.

LDL>190

10yr ASCVD risk >7.5%

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Moderate Intensity dose for the following:

ASCVD like PAD, CAD, TIA, CVA if more than >75yrs.

LDL>80 in DM patients.

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Increase the dose if cholesterol does not go down adequately with lower doses.

If patient develops statin induced myalgia, first stop statin until CK and symptoms improve.

Ezetimibe can be added if response is not adequate even with statin.

PCS K9 inhibitor like EVOLOCUMAB [=Repatha] can be added if patients can’t tolerate statins.

Stop statins in CHF and ESRD patients if there are side effects.

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Bonus point: If any patient is started on Amiodarone, Dose of Simvastatin and Digoxin should be decreased if they are on them already.

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