Who should be offered high dose statin treatment for primary prevention?
- <84 with their Q-RISK score measuring over 10%
- T1DM patients who are >40, have had diabetes for >10 years or have other CVD risk factors
- With CKS, or familial hypercholesterolaemia
What is high dose statin treatment?
Atorvastatin 20mg
Who should receive high intensity statin treatment?
Existing CVD
What is high intensity statin treatment?
Atorvastatin 80mg
What is the aim of statin treatment?
Greater than 40% reduction in non-HDL-C levels
What blood tests should be done before commencing statin treatment?
- Non fasting lipid profile
- LFT’s
- Renal function including eGFR
- Hba1C
- CK (if persistent muscle pain)
- TSH if dyslipidaemia is present
When should you suspect familial hypercholesterolaemia?
- Total cholesterol >7.5mmol/L
and/or - Personal or family history of premature CHD
What else should you assess in a patient with high cholesterol?
- Alcohol consumption
- Blood pressure
- BMI
- Smoking status
What are the adverse affects for statin treatment?
- Myopathy*
- Rhabdomyolysis*
- Muscle aches, joint swelling, back pain
- Headache
- GI upset
- Nasopharyngitis
- Hyperglycaemia
- Weight gain
How do statins work?
- Inhibit HMG-CoA reductase, an enzyme involved in cholesterol synthesis
- Increases livers ability to clear the LDL-C in the blood
What are contraindications to statin treatment?
- People with active liver disease, or abnormal LFT’S
- Pregnancy/breastfeeding
- Fertile women not on contraception
What are cautions to statin treatment?
Predisposition to rhabdomyolysis -
- Renal impairment
- Hypothyroidism
- Muscle pains
- Alcoholic liver disease
- History of hemorrhagic stroke
What are some important interactions with statins?
- Amiodarone (myopathy risk)
- Ciclosporin (inc statin in blood)
- CCB’S (inc statin in blood)
- Any -azoles
- Ticagrelor (inc statin in blood)
What monitoring is required for statins?
- Repeat LFT’S at 3 and 12 months
- Check CK if unexplained muscle symptoms
- HbA1C at 3 months if high risk of diabetes
What advise should you give to a patient regarding taking statins?
- Seek medical advise if muscle symptoms (pain, tenderness, weakness), symptoms of ILD (dyspnoea, non productive cough)
- No grapefruit juice, no St Johns Wort
- Atorvastatin any time, others at night
- Need to be on contraception
How are statins eliminated?
- By the liver
