Initiation of Therapy
From the Clinical Practice Guidelines for the Management of Dyslipidemia by the Philippine Heart Association
This guideline starts below.
Initiation of Therapy
Based on the consensus guidelines on primary and secondary prevention, the initiation of statins is an option in patients with no established atherosclerosis but with multiple risk factors and total cholesterol greater than 190 mg/dl or LDL greater than 100 mg/dl. It is recommended for diabetic patients and those with established atherosclerosis when total cholesterol is greater than 190 mg/dl or LDL greater than 100 mg/dl. However, cost should be considered for the underprivileged. For patients who opt to defer screening, the initiation of statin therapy may still be given as an option after proper patient education (informed patient choice).
The following statin doses have been used in outcome trials and have demonstrated an approximate LDL reduction of 30% to 40% from baseline:
- lovastatin 20 to 40 mg/day
- atorvastatin 10 to 80 mg/day
- pravastatin 10 to 40 mg/day
- fluvastatin 80 mg/dl
- simvastatin 20 to 80 mg/day
Fibrates may be initiated as an alternative to statins in diabetic patients with no established atherosclerosis and with HDL less than 35 mg/dl and LDL less than 90 mg/dl. The following fibrate regimens were used in clinical studies:
- gemfibrozil 1,200 mg/day
- fenofibrate 200 mg/day
- bezafibrate 400 mg/day
