Moderate Intensity Statin Therapy

Introduction to Moderate Intensity Statins

Moderate intensity statins, which lower LDL cholesterol by 30-49%, include atorvastatin 10-20 mg, rosuvastatin 5-10 mg, simvastatin 20-40 mg, pravastatin 40-80 mg, lovastatin 40 mg, fluvastatin XL 80 mg, and pitavastatin 1-4 mg 1, 2, 3

Moderate intensity statins reduce LDL cholesterol by 30-49% from baseline 1, 2, 3
The American Diabetes Association recommends moderate intensity statins for primary prevention in patients with diabetes aged 40-75 years without additional ASCVD risk factors 5, 6
For patients who cannot tolerate high-intensity statins, the maximum tolerated dose of moderate-intensity statins should be used 1, 7

For adults >75 years of age with diabetes, moderate-intensity statin therapy is recommended regardless of ASCVD risk factors 1, 5
The risk-benefit profile should be routinely evaluated in older patients, with downward titration of dose performed as needed 7
Patients who do not tolerate the intended intensity of statin should receive the maximum tolerated statin dose 1, 7
Recent evidence suggests that high-intensity statins may increase the risk of new-onset diabetes compared to moderate-intensity statins (36% vs 10% relative increase) 8

For primary prevention in moderate-risk patients, the goal is typically a 30-49% reduction in LDL-C 1, 2, 3
For high-risk patients, if moderate-intensity statins don't achieve LDL-C goals, consider adding ezetimibe or a PCSK9 inhibitor rather than increasing to high-intensity statins if there are tolerability concerns 5, 7