Risk Category LDL-C goal Initiate TLC2 Consider Drug Therapy2

High risk: CHD or CHD <100 mg/dL (optional: <70 ≥100 mg/dL ≥100 mg/dL (optional goal:
3
equivalents (10-year mg/dL) <100 mg/dL)
4
risk of CHD >20%)

Moderately high risk: 2+ <130 mg/dL (optional: <100 ≥130 mg/dL ≥130 mg/dL (optional: 100-
5
risk factors (10-year mg/dL) 129 mg/dL)
risk of CHD 10-20%)

Moderate risk: 2+ risk <130 mg/dL ≥130 mg/dL ≥160 mg/dL

factors (10-year risk of
CHD <10%)
Lower risk: 0-1 risk factor <160 mg/dL ≥160 mg/dL ≥190 mg/dL (optional: 160-
190 mg/dL)
 Usual starting does Max dose
Lovastatin 20 mg 80 mg
Pravastatin 20 mg 40 mg
Simvastatin 20 mg 80 mg
Fluvastatin 20 mg 80 mg
Atorvastatin 10 mg 80 mg
Rosuvastatin 10 mg 40 mg
Low-Density Lipoprotein
(LDL) Cholesterol High-Density Lipoprotein (HDL) Total Triglyceride
Therapy Concentration Cholesterol Concentration Concentration Other Effects

HMG-CoA ↓20-50% ↑10% ↓10-40% Increase in

reductase hepatic LDL
inhibitors receptors.
 A D M E
HMG-CoA Intestinal 30%-85% 5-30% free drugs Mostly hepatic >70% by liver
reductase inhibitors
Fibrates >90% + meal Peak 1-4 h, >95% Mostly hepatic 60-90% urine
bound to protein
Bile acid resins Not systemically Not distributed Not metabolized Gastrointestinal
absorbed tract
Nicotinic acid Almost entirely Peak 30-60 minutes Mostly hepatic Lower dose :
absorbed hepatic
Higher dose : urine
Ezetimibe Intestinal Enterohepatic Glucuronidated in 70% feces 10%
epithelium recirculation the intestinal urine
epithelium
Omega-3 fatty Small intestines, T1/2 50 – 80 h No data No data
acids administered with
food
 Interaction Side Effects
HMG-CoA Inducers : erythromycin, itraconazole - Hepatotoxicity
reductase - Myopathy
inhibitors
Fibrates As an inhibitor of statin metabolism GI side effects, rash, urticaria,
hair loss, myalgia
Bile acid resins Interfere with the absorption of furosemide, Bloating, dyspepsia
thiazides, propanolol
Nicotinic acid w/ carbamazepine as an inhibitor Flushing, dyspepsia,
hepatotoxicity, niacin induced
insulin resistance
Ezetimibe Combination w/ statin should not be used in Allergic reaction, not well studied
childbearing woman without contraception
Omega-3 fatty No data Athralgia, nausea, fishy burps,
acids dyspepsia, increased LDL