Major Recommendations for Statin Therapy for
Guidance for High-Intensity and
Atherosclerotic Cardiovascular Disease Prevention Moderate Intensity Statin Dosing
2013 ACC/AHA Blood Cholesterol Guideline
Patients over 21 years old and High-Intensity Statins
candidate for statin therapy • Atorvastatin 40-80 mg
• Rosuvastatin 20-40 mg
Moderate-Intensity Statins
Clinical
Yes Age ≤ 75 and Yes High-Intensity Statin • Atorvastatin 10–20 mg
atherosclerotic
candidate for high- Daily dose lowers LDL-C • Rosuvastatin 5–10 mg
cardiovascular
intensity statin by approx ≥ 50%
disease • Simvastatin 20–40 mg
• Pravastatin 40–80 mg
No Moderate-Intensity Statin
No Daily dose lowers LDL-C • Lovastatin 40 mg
by approx 30-50% • Fluvastatin XL 80 mg
• Fluvastatin 40 mg bid
Yes • Pitivastatin 2–4 mg
LDL-C ≥ 190 mg/dl High-Intensity Statin
Yes Patients over age 75
High-Intensity Statin
No For patients with clinical CVD, moderate-to-high
intensity statins if tolerated.
For all other indications, consider comorbidities,
Type 1 or 2 Yes Estimated 10 yr No safety, and priorities of care before initiating or
Diabetes atherosclerotic CVD Moderate-Intensity Statin
age 40-75 risk ≥ 7.5% continuing statin therapy.
Calcium Scoring Considerations
For individuals at intermediate risk (5%-7.5%) or
No
those who are unsure about their risk, consider
calcium scoring.
Age 40-75 A CAC score of zero is associated with a very low
Estimated 10 yr Yes Moderate-to-High- CVD event rate and those individuals are unlikely to
atherosclerotic CVD Intensity Statin benefit from statin therapy.*
risk > 7.5%
A CAC score ≥100 is associated with an elevated
risk of a CVD event (> 20%) regardless of traditional
No Algorithm adapted from Stone NJ, et. al. 2013 ACC/AHA guideline
risk factors.*
on the treatment of blood cholesterol to reduce atherosclerotic
If risk is 5-7.5%, consider moderate
cardiovascular risk in adults: a report of the American College of Online CVD Risk Calculator
Cardiology/American Heart Association Task Force on Practice
intensity statin if: LDL > 160 mg/dl, Guidelines. Circulation 2013; 0000437738.63853.7a
Go to www.heart.org and search “cv risk calculator”
family history, hs CRP > 2, CAC>300 for online web application.
*Calcium scoring considerations are provided by Minneapolis Heart
or 75%, ABI < .9, or high lifetime risk. Institute® and are not part of the official ACC/AHA Guidelines.
Minneapolis Heart Institute®
mplsheart.com Center for Preventive Cardiology
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