Statin Use Recommendations | June 2020 | Clinical Corner

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The 2013 American College of Cardiology (ACC) / American Heart Association (AHA) lipid guidelines represented a paradigm shift in the treatment of dyslipidemia. The 2017 American Diabetes Association Standards of Medical Care in Diabetes make similar recommendations. In a continued effort to improve outcomes and provide quality care, we are contacting you with new clinical guidelines, and talking points to your patients, regarding the use of statins. Patients will need your help "buying in" to statin therapy due to conflicting information in the media and online about risks and benefits.

  • Keep in mind, statin use is now a CMS quality measure for patients with CV disease, diabetes patients ages 40 to 75 years with an LDL of 70 to 189 mg/dL, or those with familial hypercholesterolemia. 
  • A statin is recommended for patients with clinical atherosclerotic heart disease, LDL 190 mg/dL or higher, or diabetes and age 40 to 75 years. For other patients, age 40 to 75 years with an LDL of 70 to 189 mg/dL, 10-year cardiovascular risk determines if a statin is appropriate.
    • For age 21-40 except if patient has diabetes and no risk factors, you can individualize statin option.
    • For age > 75, consider stopping statins in patients with life expectancy <1 year, or advanced dementia.
  • Clarify statin benefits. Point out that taking a statin for about 5 years prevents one CV event in every 20 patients WITH CV disease...and one in every 50 high-risk patients WITHOUT CV disease. The higher the risk, the greater the potential benefit, even if cholesterol isn't elevated.
  • Reassure patients that statins' CV benefits outweigh any small diabetes risk, liver disease linked to statins is very rare, and statins do not cause dementia or cancer. 
  • Explain that muscle pain is rarely harmful, and fewer than one in 23,000 statin patients will develop rhabdomyolysis.
  • Don't rely on supplements. Fish oil supplements are not a reliable substitute for statins.
  • Red yeast rice isn't safer than a statin. It may contain lovastatin, which is produced when rice is fermented with yeast.
  • Save ezetimibe or possibly a PCSK9 inhibitor (Praluent, Repatha) for patients with CV disease who can't take a statin, or don't get the expected LDL-lowering. But there's no proof either improves CV outcomes when used alone.
  • Ensure most patients with atherosclerotic cardiovascular disease or LDL 190 mg/dL or higher are getting a high-intensity statin.