Statin Therapy for Patients at High Risk of Cardiovascular Disease

Risk Assessment and Classification

The European Society of Cardiology recommends that patients at very high cardiovascular risk should aim for LDL-C <1.4 mmol/L (<55 mg/dL) and at least 50% reduction from baseline 1, 2
The European Society of Cardiology recommends that patients at high cardiovascular risk should aim for LDL-C <2.6 mmol/L (<100 mg/dL) 2, 3
Risk factors for cardiovascular disease include dyslipidemia, diabetes, hypertension, and smoking, as identified by the American Heart Association 3, 4

The American College of Cardiology recommends high-intensity statin therapy for adults with clinical ASCVD (secondary prevention) 5
The American College of Cardiology recommends high-intensity statin therapy for adults with diabetes mellitus who have multiple ASCVD risk factors 3, 5
The American College of Cardiology recommends high-intensity statin therapy for adults with LDL-C ≥190 mg/dL 3, 5
The American College of Cardiology recommends high-intensity statin therapy for adults at high risk (≥20% 10-year ASCVD risk) 5

The European Society of Cardiology recommends high-intensity statins for very high-risk patients to achieve ≥50% LDL-C reduction 1, 2
The American Heart Association recommends moderate to high-intensity statins for high-risk patients based on individual risk factors 3, 5
The American College of Physicians recommends moderate-intensity statins for moderate-risk patients (7.5-10% 10-year risk) with consideration of risk-enhancing factors 6, 4

The European Society of Cardiology recommends assessing LDL-C levels 4-12 weeks after initiating therapy to evaluate response and adjust dosage if necessary, and considering adding ezetimibe if target LDL-C levels are not achieved with maximally tolerated statin therapy 1, 2
The European Society of Cardiology recommends considering PCSK9 inhibitors for very high-risk patients with persistent elevated LDL-C despite maximum statin plus ezetimibe 1, 2, 7

The European Society of Cardiology states that statins are contraindicated in women of childbearing potential 1, 2

The American Diabetes Association recommends moderate-intensity statin therapy for diabetes patients regardless of estimated 10-year ASCVD risk, and high-intensity statins for those with multiple risk factors 3
The American Geriatrics Society recommends an individualized approach for elderly patients (>75 years) based on comorbidities and risk factors 6, 4