Cardiovascular Risk Reduction with Statin Therapy

Initial Statin Selection and Treatment Goals

The American College of Cardiology (ACC) and American Heart Association (AHA) consider family history of premature ASCVD as a risk-enhancing factor, and recommend atorvastatin therapy for patients with elevated LDL-C and family history of MI, with a target LDL-C reduction of at least 30-40% 1
The ACC/AHA guidelines recommend a target LDL-C reduction of at least 30-40%, and consider more aggressive LDL-C goal of <100 mg/dL for patients with risk enhancers, with a strength of evidence based on clinical trials 2

The American College of Cardiology recommends checking lipid panel 4-12 weeks after initiating therapy, and assessing for muscle symptoms at follow-up visits, with consideration of dose titration if LDL-C goal is not achieved 3

The American Heart Association recommends considering adding ezetimibe as the next step if LDL-C goal is not achieved with statin monotherapy, and avoiding combining high-dose statins with fibrates due to increased risk of myopathy, with a strength of evidence based on clinical trials 2
The American College of Cardiology recommends a diet low in saturated fat (<7% of total calories) and cholesterol (<200 mg/day), increased consumption of plant stanols/sterols (2 g/day) and soluble fiber (10-25 g/day), regular physical activity (30-60 minutes most days), and weight management if needed, as complementary strategies to statin therapy 4