STATIN THERAPY INITIATION

ACC/AHA GUIDELINES 2013

• “2013 ACC/AHA Guideline on the treatment of blood
cholesterol to reduce Athesclerotic Cardiovascular
Risk in Adults
o American College of Cardiology (ACC) and
American Heart Association (AHA) in
collaboration with NHLBI
o Adults ≥ 21 years
• Focus on ASCVD risk reduction
o ASCVD Calculator
• Population-Based
o Identified four groups that would benefit
the most from treatment
o Emphasis on medications proven to lower
ASCVD events

ASCVD: ATHEROSCLEROTIC CARDIOVASCULAR DISEASE

• Clinical ASCVD
o CHD (MI, stable or unstable angina)
o Coronary or other arterial revascularization
o Stroke or transient ischemic attack (TIA)
o Peripheral arterial disease (PAD)
o All of presume atherosclerotic origin
• Primary prevention: therapy aimed at preventing
the first event
• Secondary prevention: therapy aimed at preventing STATION THERAPY INTENSITY
a subsequent event HIGH-INTENSITY MODERATE-INTENSITY LOW-INTENSITY
↓ LDL 50% ↓ LDL 30% to < 50% ↓ LDL < 30%
Atorvastatin 40, 80 mg Atorvastatin 10 (20) mg Simvastatin 10 mg
LIMITATIONS TO ACC/AHA GUIDELINES Rosuvastatin 20 (40) Rosuvastatin (5) 10 mg Pravastatin 10, 20 mg
• Patients with TG > 500 mg/dL mg Simvastatin 20, 40 mg Lovastatin 20 mg
Pravastatin 40 (80) mg Fluvastatin 20, 40 mg
o High risk for pancreatitis Lovastatin 40 mg Pitavastatin 1 mg
o Screen for secondary causes Fluvastatin XL 80 mg
o Lifestyle modifications Fluvastatin 40 mg BID
o Medications targets TG used initially Pitavastatin 2 – 4 mg
• Minimal evidence for people > 75 years
• Insufficient evidence for people with: MONITORING STATIN THERAPY
o New York Heart Association (NHYA) class II- • WHEN
IV heart failure o Baseline
o Maintenance hemodialysis o Within 4-12 weeks after initiation or
• Controversial among clinicians dose adjustment
• Possibly overestimation of risk o then every 3-12 months
o Age significantly increases risk
• WHY
• ASCVD Risk Calculator limited to:
o Statin-naive people
o Monitor expected response and/or
▪ Assess appropriateness of statin if adherence
already on therapy ▪ High-intensity: LDL ↓≥ 50%
o African-Americans, Caucasians, “Other ▪ Moderate-intensity: LDL 30% to
o Age 20-79 years old < 50%
▪ 10-yr ASCVD risk40-79 years o Can target LDL ≤ 70 mg/dL in high risk
▪ Lifetime ASCVD risk 20-59 years patients
o TC 130-320 mg/Dl

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MONITORING STATIN THERAPY

PHILIPPINE GUIDELINES
• The Philippine Heart Association, the Philippine Lipid and
Atherosclerosis Society, and the Philippine Society of
Endocrinology, Diabetes, and Metabolism, collaborated to
develop the 2015 Clinical Practice Guidelines for the
Management of Dyslipidemia in the Philippines (2015CPG).
• The main objective for this document is to develop clinical
guidelines in the management of Filipino patients who are
diagnosed with elevated cholesterol.

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