ASCVD Risk Reduction and Statin Use Protocol

• Statins are first-line medications to reduce ASCVD risk
• Used for both primary and secondary prevention
• Shared decision making is essential to select appropriate patients
• Follow guideline recommendations on intensity of statin based on risk factors

Secondary Prevention

• Use high-intensity statin lifelong for patients with history of ASCVD events
• Preferred statins at St Vincent’s are:
  • Rosuvastatin 20-40 mg daily
  • Atorvastatin 40-80 mg daily
• If not tolerated, use medium-intensity statin plus ezetimibe
• If LDL still >70 mg/dL, add PCSK9 inhibitor

Primary Prevention

• Use risk calculators to estimate 10-year ASCVD risk
• Indications for statin:
  • LDL >190 mg/dL: High-intensity statin
  • Diabetes age 40-75 years: At least moderate-intensity statin
  • 10-year ASCVD risk ≥20%: High-intensity statin
  • 10-year ASCVD risk 7.5-20%: Consider moderate-intensity statin
• Preferred statins based on clinical context:
  • Rosuvastatin
  • Atorvastatin
  • Pravastatin

Tips for Use

• Use non-fasting lipid panel for screening
• Get baseline LFTs, CK, TSH before initiating
• Monitor CK if myalgias develop, routine monitoring not needed
• Discuss risks/benefits and engage in shared decision making

Conclusion

• Statins significantly reduce ASCVD when used appropriately
• Follow evidence-based recommendations on proper patient selection and intensity
• Engage patients in shared decision making throughout process