Use of Statins Flashcards
What baseline and clinical assessments does NICE recommend before starting statin therapy?
- Smoking status
- Alcohol consumption
- BP
- BMI
- Lipid profile: total cholesterol, non-HDL cholesterol and triglycerides
- Diabetes status
- Renal function
- LFTs: transaminase level
- TSH - hypothyroidism
What medication is prescribed as primary prevention for people with or without type 2 DM, if their 10-year QRISK3 score >10%?
Atorvastatin 20mg DAILY
For patients older that 85 years, what medication is considered for primary prevention?
Atorvastatin 20mg
What medication is prescribed as primary prevention for people with Type 1 DM?
Atorvastatin 20mg DAILY for all Type 1 DM
Offer when:
- > 40 years old
or
- DM >10 years or
or
- Established nephropathy
or
- Other CVD risk factors
What medication is prescribed as secondary prevention for people with or without type 2 DM?
Atorvastatin 80mg DAILY
- Lifestyle recommendations made at the same time
- Offer lower if:
1. Drug interactions
2. High risk ADRs (adverse drug reactions)
3. Patient preference
What is the medication prescribed as primary or secondary prevention for people with Chronic Kidney Disease (CKD)?
Atorvastatin 20mg DAILY
- I target reduction is not achieved and eGFR >30 then increase dose
- If eGFR <30 then agree higher dose with renal specialist
What do low -intensity statin do are name some examples.
Will reduce cholesterol by 20-30%
Examples:
- 10mg Pravastatin
- 20mg Pravastatin
- 40mg Pravastatin
- 20mg Fluvastatin
- 40mg Fluvastatin
- 10mg Simvastatin
What do medium -intensity statin do are name some examples.
Will reduce cholesterol by 31-40%
Examples:
- 80mg Fluvastatin
- 20mg Simvastatin
- 40mg Simvastatin
- 5mg Rosuvastatin
- 10mg Atorvastatin
What do high -intensity statin do are name some examples.
Will reduce cholesterol above 40%
Examples:
- 80mg Simvastatin (not recommended due to risk of muscle toxicity)
- 20mg Atorvastatin
- 40mg Atorvastatin
- 80mg Atorvastatin
- 10mg Rosuvastatin
- 20mg Rosuvastatin
- 40mg Rosuvastatin
What target cholesterol reduction should we be aiming for when we have a patient who is prescribed a statin, whether that be primary or secondary prevention?
We should be aiming for:
1. At least >40% reduction in NON-HDL cholesterol
- HDL cholesterol > 1mmol/L
How do we monitor patients before starting statins?
- Full lipid profile measured: Total cholesterol, HDL cholesterol, non-HDL cholesterol, Triglycerides
- Liver function tests - LFTs (AST/ALT) - to see if its safe to commence to a statin according to their liver function
How do we monitor patients at 3 months of taking statins?
- Total cholesterol, HDL cholesterol, non-HDL cholesterol
- Liver function tests (LFTs)
- If >3 times upper limit of normal, discontinue and recheck in 1 month (if elevated but <3 times upper limit of normal continue statin (safe) and recheck in 1 month)
Why do we need to monitor Creatine Kinase (CK)?
This is an enzyme that is released when a muscle is damaged. We only check CK in patients taking statins if they develop any signs of statin related muscle toxicity.
What should be done is a great that 40% reduction in non-HDL cholesterol is not achieved?
- Discuss adherence and timing of dose
- Optimise adherence to diet and lifestyle measures
- Consider increasing the dose if started on less that Atorvastatin 80mg and the person is judged to be at higher risk of comorbidities, risk score or using clinical judgement
What follow-up monitoring should be conducted if the patient is on a stable dose of Atorvastatin?
- Lipid profile and LFTs monitored at 12months and then annually
- If up titration is required -> recheck after 3 months
