Guidelines for reducing cardiovascular risk from the American Heart Association and the American College of Cardiology identify four high-risk groups most likely to benefit from cholesterol-lowering statin therapy:
1. Anyone with a history of cardiovascular disease, including heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization
2. Anyone age 40 to 75 who has type 1 or type 2 diabetes
3. Anyone with a very high level of LDL cholesterol (190 mg/dL or above)
4. Anyone age 40 to 75 years without cardiovascular disease whose estimated 10-year risk of having a heart attack or stroke is 7.5 percent or higher, as determined by a risk calculator that takes into account age, gender, race, total cholesterol, HDL cholesterol, blood pressure, use of blood pressure medication, diabetes status, and smoking habits.
If your risk score is borderline and there is uncertainty about whether to start statin therapy, your doctor may order certain tests to better assess your risk, including:
• Coronary artery calcium scan to assess calcium buildup in the artery walls
• High-sensitivity C-reactive protein blood test to check for inflammation linked to coronary risk
• Ankle brachial index to assess blockages in leg arteries
Dosing and monitoring
Patients starting on a statin no longer need to try different drug and dosage combinations to reach an LDL cholesterol target, as in the past. Instead, the guidelines specify a “high-intensity” or “moderate-intensity” statin regimen, depending on your risk profile.
If you’re a primary prevention patient—you have no known cardiovascular disease—you and your doctor should discuss your individual risk profile and treatment preferences.
For someone starting on a statin, the guidelines recommend a cholesterol test (lipid panel) after one to three months to check for response and adherence to the drug and to assess the effects of diet and other lifestyle factors that can affect cholesterol levels. Your doctor will also want to monitor you for side effects. Thereafter, yearly checks are advised.