Hypercholesterolaemia and Triglyceridemia
NOTE: Statins are the drugs of first choice for treating hypercholesterolaemia and moderate hypertriglyceridaemia–> When not controlled on maximum dose of statin, ezetimibe can be used under specialist supervision
Statins: Effective in lowering lipid cholesterol
Fibrates: Effective at lowering triglycerides
- Fenofibrate may be added to statin therapy if triglycerides remain high even after the LDL-cholesterol concentration has been reduced adequately.
Cholesterol Markers and Primary Prevention
| Primary Prevention CVD- Offer High intensity Atorvastatin 20mg |
| Aged 84 years and younger- estimated 10-year risk of developing CVD using the QRISK assessment tool is 10% or more. |
| With type 1 diabetes: Who are aged more than 40 years Had diabetes for more than 10 years Have established nephropathy or Other CVD risk factors. |
| With chronic kidney disease, or familial hypercholesterolaemia (without the need for a formal risk assessment). |
| Primary Prevention CVD- Consider High intensity Atorvastatin 20mg- without the need for a formal risk assessment |
| TYPE 1 diabetes |
| Aged 85 years of age or older, taking into account the benefits and risks of treatment and any comorbidities that make treatment appropriate. |
| Secondary Prevention CVD- Offer High intensity Atorvastatin 80mg |
| Myocardial infarction Angina Stroke Transient ischaemic attack Peripheral arterial disease |
| The aim is to achieve a greater than 40% reduction in non-HDL-C levels. Before starting lipid modification therapy, the following baseline blood tests should be performed: A non-fasting lipid profile. Liver function tests (transaminases). Renal function, including estimated glomerular filtration rate. HbA1c. Creatine kinase (if the person has persistent generalized unexplained muscle pain) do not initiate if 5 times the upper limit of normal Thyroid stimulating hormone, if dyslipidaemia is present. |
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Simvastatin |
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Manufacturer advises max. 10 mg daily |
Manufacturer advises max. 20 mg daily | Manufacturer advises max. 40 mg daily |
| Concurrent use of bezafibrate or ciprofibrate. |
Amlodipine |
Lomitapide |
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Amiodarone |
Ticagrelor |
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Ranolazine |
Patients with severe hypercholesterolaemia and at high risk of cardiovascular complications |
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Use of some moderate inhibitors of CYP3A4 (Verapamil and Diltiazem |
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Bempedoic acid or Bempedoic acid with ezetimibe |
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Atorvastatin |
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| Manufacturer advises max. 10 mg daily |
Manufacturer advises max. 20 mg daily |
| If ciclosporin is unavoidable, max. dose cannot exceed 10 mg daily |
Elbasvir with grazoprevir. |
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Letermovir (without ciclosporin) |
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Sofosbuvir with velpatasvir and voxilaprevir. |
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Pravastatin |
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| Half Dose | Maximum 20mg | Maximum 40mg |
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Ombitasvir with paritaprevir |
glecaprevir with pibrentasvir | sofosbuvir with velpatasvir and voxilaprevir. |
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Rosuvastatin
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| Initially 5mg [40 mg dose is contraindicated] |
Initially 5 mg daily [maximum 20mg daily] |
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With concurrent use of: Bezafibrate Ciprofibrate Fenofibrate |
Clopidogrel |
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Fluvastatin |
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Maximum 20mg |
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Elbasvir with grazoprevir |
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Statin Intensity |
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Therapy intensity |
Drug |
Daily dose (reduction in LDL cholesterol) |
Daily dose (reduction in LDL cholesterol) in order of statin intensity |
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High-intensity |
Atorvastatin |
20 mg (43%) |
Atorvastatin 80 mg (55%) |
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40 mg (49%) |
Rosuvastatin 40 mg (53%) |
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80 mg (55%) |
Atorvastatin 40 mg (49%) |
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Rosuvastatin |
10 mg (43%) |
Rosuvastatin 20 mg (48%) |
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20 mg (48%) |
Atorvastatin 20 mg (43%) |
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40 mg (53%) |
Rosuvastatin 10 mg (43%) |
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Simvastatin |
80 mg (42%) |
Simvastatin 80 mg (42%) |
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Medium-intensity |
Atorvastatin |
10 mg (37%) |
Rosuvastatin 5 mg (38%) |
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Fluvastatin |
80 mg (33%) |
Atorvastatin 10 mg (37%) |
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Rosuvastatin |
5 mg (38%) |
Simvastatin 40 mg (37%) |
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Simvastatin |
20 mg (32%) |
Fluvastatin 80 mg (33%) |
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40 mg (37%) |
Simvastatin 20 mg (32%) |
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Low-intensity |
Fluvastatin |
20 mg (21%) |
Pravastatin 40 mg (29%) |
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40 mg (27%) |
Simvastatin 10 mg (27%) |
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Pravastatin |
10 mg (20%) |
Fluvastatin 40 mg (27%) |
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20 mg (24%) |
Pravastatin 20 mg (24%) |
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40 mg (29%) |
Fluvastatin 20 mg (21%) |
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Simvastatin |
10 mg (27%) |
Pravastatin 10 mg (20%) |
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