High-Intensity vs. Low-Intensity Statin Therapy


The MD Magazine Peer Exchange “Amassing the Clinical Evidence for Optimized Dyslipidemia Management: Vitamin D, Long-Term Statin Outcomes, and PCSK9 Inhibition” features expert insight and analysis of the latest information on managing hypertension and hyperlipidemia, and in-depth discussion on the use of PCSK9 inhibitors in practice.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

  • Christie Ballantyne, MD, Co-director of the Lipid Metabolism and Atherosclerosis Clinic at The Methodist Hospital, Director of the Center for Cardiovascular Disease Prevention at the Methodist DeBakey Heart Center, and the Chief of Cardiology at Baylor College of Medicine
  • Keith C. Ferdinand, MD, Immediate Past Chair of the National Forum for Heart Disease and Stroke Prevention, and Professor of Clinical Medicine at the Heart and Vascular Institute at Tulane University School of Medicine
  • Jennifer G. Robinson, MD, MPH, Professor in the Departments of Epidemiology & Medicine and Director of the Prevention Intervention Center, Department of Epidemiology at the College of Public Health, University of Iowa
  • Karol E. Watson, MD, PhD, Professor of Medicine and Cardiology, Co-director of the UCLA Program in Preventive Cardiology, and Director of the UCLA Barbra Streisand Women’s Heart Health Program

Dr. Robinson and the other panelists discuss outcomes from clinical trials that assessed the effect of statin dosage on participants’ LDL levels and debate the definition of “high-intensity” statin therapy.

Researchers conducted three trials of high intensity-statins that show “high-intensity statins reduce events more than moderate-intensity statins. That’s why it’s a 1a recommendation for high-intensity statins in people with clinical cardiovascular disease,” Dr. Robinson said.

Dr. Salgo noted that the focus on statin dose is interesting, because he said his instinct is that if you can get the patient’s LDL levels to the desired target using a smaller statin dose. IF this is the case, he asked “Why go to atorvastatin 80 mg unless you tell me that there’s an additional benefit?”

It’s the LDL level that counted in those studies, not the drug, said Dr. Ballantyne. The recommendations for treatment based on the study data are evidence-based, “but if you actually dig into the details, it ends up you have to use clinical judgment” when prescribing these drugs, he said.

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