User Tools

Site Tools

Trace: • pain • dhp • oxycodone • first_generation_h1
cardio:lipids:statins

Differences

This shows you the differences between two versions of the page.

Link to this comparison view

Both sides previous revisionPrevious revision
cardio:lipids:statins [2026/02/12 22:31] – andrew2393cnscardio:lipids:statins [2026/02/13 17:45] (current) – andrew2393cns
Line 1: Line 1:
 ====== Statins ====== ====== Statins ======
  
-Statins are HMG-CoA reductase inhibitors and are first-line therapy for reducing LDL cholesterol and preventing ASCVD.+Statins are [[cardio:lipids:start|HMG-CoA reductase inhibitors]] and are first-line therapy for LDL reduction and prevention of atherosclerotic cardiovascular disease (ASCVD).
  
-Primary Outcomes: +They are outcome-driven therapies.
-• ↓ Myocardial infarction +
-• ↓ Ischemic stroke +
-• ↓ Cardiovascular mortality +
-• ↓ All-cause mortality (high-risk patients)+
  
-Statins are mortality drugs.+Primary Benefits: 
 +  * ↓ Myocardial infarction 
 +  * ↓ Ischemic stroke 
 +  * ↓ Cardiovascular mortality 
 +  * ↓ All-cause mortality (high-risk patients)
  
-----+Greater LDL reduction correlates directly with greater event reduction. 
 + 
 +--------------------------------------------------------------------
  
 ===== Mechanism of Action ===== ===== Mechanism of Action =====
  
-• Inhibit HMG-CoA reductase (rate-limiting step in cholesterol synthesis) +Primary Target: 
-• ↓ Hepatic cholesterol production +  * HMG-CoA reductase (rate-limiting step in hepatic cholesterol synthesis)
-• ↑ LDL receptor expression +
-• ↑ LDL clearance from circulation+
  
-Greater LDL reduction → greater event reduction.+Physiologic Effects: 
 +  * ↓ Hepatic cholesterol production 
 +  * ↑ LDL receptor expression 
 +  * ↑ Clearance of circulating LDL
  
-----+Net Result: 
 +  * ↓ LDL cholesterol (dose-dependent) 
 +  * Plaque stabilization 
 +  * Reduced inflammatory signaling 
 + 
 +--------------------------------------------------------------------
  
 ===== Complete Statin Master Table ===== ===== Complete Statin Master Table =====
  
-^ Drug ^ Dose Range ^ Intensity ^ LDL ↓ % ^ CYP Metabolism ^ Lipophilic vs Hydrophilic ^ Key Clinical Pearls ^ +^ Drug ^ Dose Range ^ Intensity ^ LDL Reduction ^ CYP Metabolism ^ Lipophilicity ^ 
-| [[cardio:lipids:atorvastatin|Atorvastatin]] | 10–80 mg | Moderate–High | 35–60% | CYP3A4 | Lipophilic | Strong outcome data; common first choice | +| [[cardio:lipids:atorvastatin|Atorvastatin]] | 10–80 mg | Moderate–High | 35–60% | CYP3A4 | Lipophilic | 
-| [[cardio:lipids:rosuvastatin|Rosuvastatin]] | 5–40 mg | Moderate–High | 45–63% | Minimal CYP2C9 | Hydrophilic | Most potent per mg; fewer interactions | +| [[cardio:lipids:rosuvastatin|Rosuvastatin]] | 5–40 mg | Moderate–High | 45–63% | Minimal CYP2C9 | Hydrophilic | 
-| [[cardio:lipids:simvastatin|Simvastatin]] | 10–40 mg | Low–Moderate | 25–45% | CYP3A4 | Lipophilic | Avoid 80 mg; high interaction risk | +| [[cardio:lipids:simvastatin|Simvastatin]] | 10–40 mg | Low–Moderate | 25–45% | CYP3A4 | Lipophilic | 
-| [[cardio:lipids:pravastatin|Pravastatin]] | 10–80 mg | Low–Moderate | 20–40% | No CYP | Hydrophilic | Useful in polypharmacy; fewer interactions | +| [[cardio:lipids:pravastatin|Pravastatin]] | 10–80 mg | Low–Moderate | 20–40% | No CYP | Hydrophilic | 
-| [[cardio:lipids:lovastatin|Lovastatin]] | 10–40 mg | Low–Moderate | 25–40% | CYP3A4 | Lipophilic | Take with food; interaction risk | +| [[cardio:lipids:lovastatin|Lovastatin]] | 10–40 mg | Low–Moderate | 25–40% | CYP3A4 | Lipophilic | 
-| [[cardio:lipids:fluvastatin|Fluvastatin]] | 20–80 mg | Low–Moderate | 20–35% | CYP2C9 | Lipophilic | Less potent; not commonly first-line | +| [[cardio:lipids:fluvastatin|Fluvastatin]] | 20–80 mg | Low–Moderate | 20–35% | CYP2C9 | Lipophilic | 
-| [[cardio:lipids:pitavastatin|Pitavastatin]] | 1–4 mg | Moderate | 30–45% | Minimal CYP | Lipophilic | Lower diabetes signal in some studies |+| [[cardio:lipids:pitavastatin|Pitavastatin]] | 1–4 mg | Moderate | 30–45% | Minimal CYP | Lipophilic |
  
-----+--------------------------------------------------------------------
  
-===== Intensity Classification (Clinical Decision Anchor) =====+===== Intensity Classification (Clinical Anchor) =====
  
 ^ Intensity ^ Expected LDL Reduction ^ Drugs ^ ^ Intensity ^ Expected LDL Reduction ^ Drugs ^
-| High-Intensity | ≥50% | Atorvastatin 40–80 mg, Rosuvastatin 20–40 mg | +| High-Intensity | ≥50% | [[cardio:lipids:atorvastatin|Atorvastatin]] 40–80 mg; [[cardio:lipids:rosuvastatin|Rosuvastatin]] 20–40 mg | 
-| Moderate-Intensity | 30–49% | Atorvastatin 10–20 mg, Rosuvastatin 5–10 mg, Simvastatin, Pravastatin, Lovastatin, Pitavastatin | +| Moderate-Intensity | 30–49% | Lower-dose Atorvastatin; Rosuvastatin 5–10 mg; Simvastatin; Pravastatin; Lovastatin; Pitavastatin | 
-| Low-Intensity | <30% | Low-dose Simvastatin, Pravastatin, Lovastatin |+| Low-Intensity | <30% | Low-dose Simvastatin; Pravastatin; Lovastatin |
  
-----+Clinical rule: 
 +Intensity selection is based on ASCVD risk — not LDL number alone.
  
-===== Pharmacokinetic Highlights =====+--------------------------------------------------------------------
  
-Highest Interaction Risk (CYP3A4): +===== Pharmacokinetic Considerations ===== 
-• Atorvastatin + 
-• Simvastatin +High Interaction Risk (CYP3A4): 
-• Lovastatin+  * [[cardio:lipids:atorvastatin|Atorvastatin]] 
 +  * [[cardio:lipids:simvastatin|Simvastatin]] 
 +  * [[cardio:lipids:lovastatin|Lovastatin]]
  
 Lower Interaction Risk: Lower Interaction Risk:
-• Rosuvastatin +  * [[cardio:lipids:rosuvastatin|Rosuvastatin]] 
-• Pravastatin +  * [[cardio:lipids:pravastatin|Pravastatin]] 
-• Pitavastatin+  * [[cardio:lipids:pitavastatin|Pitavastatin]]
  
 Hydrophilic (less muscle penetration): Hydrophilic (less muscle penetration):
-• Rosuvastatin +  * Rosuvastatin 
-• Pravastatin+  * Pravastatin
  
 Lipophilic: Lipophilic:
-• Atorvastatin +  * Atorvastatin 
-• Simvastatin +  * Simvastatin 
-• Lovastatin +  * Lovastatin 
-• Fluvastatin +  * Fluvastatin 
-• Pitavastatin+  * Pitavastatin
  
-----+--------------------------------------------------------------------
  
 ===== Class Adverse Effects ===== ===== Class Adverse Effects =====
  
-Myopathy Spectrum: +Muscle: 
-• Myalgias (most common) +  * Myalgias (most common) 
-• Myositis +  * Myositis 
-• Rhabdomyolysis (rare)+  * Rhabdomyolysis (rare)
  
 Hepatic: Hepatic:
-• Mild ALT elevation possible+  * Mild ALT elevation
  
 Metabolic: Metabolic:
-• Slight ↑ risk of new-onset diabetes +  * Slight ↑ risk of new-onset diabetes 
-• Benefit outweighs risk+  * Cardiovascular benefit outweighs risk
  
-Risk increases with: +Risk Factors for Myopathy: 
-• High dose +  * High-dose therapy 
-• Drug interactions +  * Drug interactions 
-• Renal impairment +  * Renal impairment 
-• Combination with fibrates (especially gemfibrozil)+  * Combination with [[cardio:lipids:fibrates:start|Fibrates]] (especially [[cardio:lipids:gemfibrozil|Gemfibrozil]])
  
-----+--------------------------------------------------------------------
  
 ===== Clinical Strategy ===== ===== Clinical Strategy =====
  
 Primary Prevention: Primary Prevention:
-• Select intensity based on ASCVD risk+  * Select statin intensity based on ASCVD risk
  
 Secondary Prevention: Secondary Prevention:
-• High-intensity statin unless contraindicated +  * High-intensity statin unless contraindicated 
-• Add [[cardio:lipids:ezetimibe|Ezetimibe]] if LDL above goal +  * Add [[cardio:lipids:ezetimibe|Ezetimibe]] if LDL remains above goal 
-• Consider [[cardio:lipids:pcsk9|PCSK9 Inhibitors]] in very high-risk patients+  * Consider [[cardio:lipids:pcsk9:start|PCSK9 Inhibitors]] in very high-risk patients 
 + 
 +Statins are foundational therapy. Other lipid agents are additive.
  
-----+--------------------------------------------------------------------
  
-===== High-Yield Clinical Pearls =====+===== High-Yield Pearls =====
  
-✔ Greater LDL reduction = greater event reduction   +  * Greater LDL reduction = greater event reduction 
-✔ High-intensity statins provide strongest mortality benefit   +  * High-intensity statins provide strongest mortality benefit 
-✔ Rosuvastatin is most potent per mg   +  * [[cardio:lipids:rosuvastatin|Rosuvastatin]] is most potent per mg 
-✔ Avoid simvastatin 80 mg   +  * Avoid simvastatin 80 mg 
-✔ Most statin intolerance can be managed   +  * Most statin intolerance can be managed with dose adjustment 
-✔ Statins are first-line unless clearly contraindicated  +  * Discontinuation increases cardiovascular risk
  
-----+--------------------------------------------------------------------
  
 Continue Lipid Therapy: Continue Lipid Therapy:
  
-→ [[cardio:lipids:ezetimibe|Ezetimibe]]+→ [[cardio:lipids:ezetimibe|Ezetimibe]]   
 +→ [[cardio:lipids:pcsk9:start|PCSK9 Inhibitors]]  
 → [[cardio:lipids:start|Back to Antilipemics]] → [[cardio:lipids:start|Back to Antilipemics]]
cardio/lipids/statins.1770935461.txt.gz · Last modified: by andrew2393cns