Statin Intolerance
Statin Intolerance.pptx (sharepoint.com)
Diagnosis and Management of Statin Intolerance - PubMed (nih.gov)
Efficacy and tolerability of once-weekly rosuvastatin in patients with previous statin intolerance
Statins in Older Patients
Clinical Controversy Statins Geriatrics_final.pptx (sharepoint.com)
In older adults without CVD, treating 100 (NNT) persons with statins for 2.5 years time-to-benefit prevented 1 MACE
Statins in Patients with HIV
Pitavastatin to Prevent Cardiovascular Disease in HIV Infection | New England Journal of Medicine
The incidence of a major adverse cardiovascular event was 4.81 per 1000 person-years in the pitavastatin group and 7.32 per 1000 person-years in the placebo group (hazard ratio, 0.65; 95% confidence interval [CI], 0.48 to 0.90; P=0.002)
Statin Therapy in People With HIV | NIH
Age 40–75 Years
When 10-year ASCVD risk estimates are 5% to <20%, the Panel for the Use of Antiretroviral Agents in Adults and Adolescents with HIV (the Panel) recommends initiating at least moderate-intensity statin therapy (AI).
Recommended options for moderate-intensity statin therapy include the following:
Pitavastatin 4 mg once daily (AI)
Atorvastatin 20 mg once daily (AII)
Rosuvastatin 10 mg once daily (AII)
When 10-year ASCVD risk estimates are <5%, the Panel favors initiating at least moderate-intensity statin therapy (CI). The absolute benefit from statin therapy is modest in this population; therefore, the decision to initiate a statin should take into account the presence or absence of HIV-related factors that can increase ASCVD risk.a
Same options for moderate-intensity statin therapy as recommended for 10-year ASCVD risk estimates of 5% to <20% (see above)
Coadministration of certain statins and antiretroviral drugs may result in significant drug–drug interactions. In some cases, the interaction may require statin dose adjustment, switching to another statin, or increased monitoring for statin-related adverse effects (see the Drug–Drug Interaction section below for details).
Risk Calculators
Statin Choice Decision AID - Site (mayoclinic.org)
The predicted event rate of 5.78% by the Framingham Risk Score and 3.51% by the Pooled Cohort Equations at 5 years overestimated observed event rates by 101% and 115%, respectively
Health Disparities
Health Disparities Across the Continuum of ASCVD Risk - PMC (nih.gov)
Using Race with Caution in the ASCVD Calculator | AAFP
Podcasts
#10 Cholesterol, lipids, statins, fish oil. Become a Master Lipidologist. - The Curbsiders
#191 Lipids Update and Cardiovascular Risk Reduction with Erin Michos MD - The Curbsiders
Articles
Dyslipidemia Management for Cardiovascular Disease Prevention: Guidelines from the VA/DoD | AAFP
Lectures
Guidelines
References
Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in J Am Coll Cardiol. 2019 Jun 25;73(24):3237-3241]. J Am Coll Cardiol. 2019;73(24):e285-e350. doi:10.1016/j.jacc.2018.11.003