Major Recommendations for Statin Therapy for Guidance for High-Intensity and Atherosclerotic Cardiovascular Disease Prevention Moderate Intensity Statin Dosing 2013 ACC/AHA Blood Cholesterol Guideline Patients over 21 years old and High-Intensity Statins candidate for statin therapy • Atorvastatin 40-80 mg • Rosuvastatin 20-40 mg

Moderate-Intensity Statins Clinical Age ≤ 75 and High-Intensity Statin atherosclerotic Yes Yes • Atorvastatin 10–20 mg candidate for high- Daily dose lowers LDL-C cardiovascular • Rosuvastatin 5–10 mg intensity statin by approx ≥ 50% disease • Simvastatin 20–40 mg • Pravastatin 40–80 mg No Moderate-Intensity Statin No Daily dose lowers LDL-C • Lovastatin 40 mg by approx 30-50% • Fluvastatin XL 80 mg • Fluvastatin 40 mg bid Yes LDL-C ≥ 190 mg/dl High-Intensity Statin • Pitivastatin 2–4 mg

Yes Patients over age 75 High-Intensity Statin No For patients with clinical CVD, moderate-to-high intensity statins if tolerated. For all other indications, consider comorbidities, Type 1 or 2 Estimated 10 yr Yes No safety, and priorities of care before initiating or Diabetes atherosclerotic CVD Moderate-Intensity Statin age 40-75 risk ≥ 7.5% continuing statin therapy. Calcium Scoring Considerations No For individuals at intermediate risk (5%-7.5%) or those who are unsure about their risk, consider calcium scoring. Age 40-75 A CAC score of zero is associated with a very low Yes Estimated 10 yr Moderate-to-High- CVD event rate and those individuals are unlikely to Intensity Statin atherosclerotic CVD benefit from statin therapy.* risk > 7.5% A CAC score ≥100 is associated with an elevated risk of a CVD event (> 20%) regardless of traditional No Algorithm adapted from Stone NJ, et. al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic risk factors.* cardiovascular risk in adults: a report of the American College of If risk is 5-7.5%, consider moderate Online CVD Risk Calculator Cardiology/American Heart Association Task Force on Practice Go to www.heart.org and search “cv risk calculator” intensity statin if: LDL > 160 mg/dl, Guidelines. Circulation 2013; 0000437738.63853.7a for online web application. family history, hs CRP > 2, CAC>300 *Calcium scoring considerations are provided by Minneapolis Heart or 75%, ABI < .9, or high lifetime risk. Institute® and are not part of the official ACC/AHA Guidelines.

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