Issues to measure:
(1) change in serum LDL-C concentration relative to baseline and intensity of statin therapy
(2) evidence for adverse events
(3) need to change statin dose or to discontinue therapy
percent reduction in serum LDL-C =
= ((baseline LDL-C) – (current LDL-C)) / (baseline LDL-C) * 100%
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Statiin Therapy
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Expected Reduction
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|
high intensity
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>= 50%
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moderate intensity
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30-50%
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If the expected reduction in LDL-C is less than expected then consider:
(1) poor adherence to regimen
(2) drug or condition associated with increased statin elimination
(3) change in statin regimen
It is worth considering the reduction of a statin dose if 2 consecutive values for LDL-C are < 40 mg/dL (after overcompliance has been ruled out).
Usually additional tests are not indicated unless specific signs and symptoms occur:
(1) CK if muscle pain, tenderness, cramping, weakness or fatigue develop
(2) liver function tests for signs of hepatitis develop
