Statin Therapy & Pharmacology Flashcards

According to ACC/AHA guidelines, high-intensity statin therapy is defined as achieving what approximate reduction in LDL-C?

Answer: At least 50% reduction from baseline

High-intensity statins (e.g., atorvastatin 40–80 mg, rosuvastatin 20–40 mg) are defined by their ability to lower LDL-C by ≥50% on average from baseline.

Statin therapy is absolutely contraindicated during pregnancy primarily because statins inhibit cholesterol synthesis needed for which fetal developmental process?

Answer: Fetal steroidogenesis and cell membrane synthesis

Cholesterol is essential for fetal steroid hormone production and cell membrane development; statins are FDA category X in pregnancy due to teratogenicity concerns.

In an elderly patient (>75 years) without established ASCVD who is statin-naive, the 2018 ACC/AHA guidelines recommend which approach?

Answer: Apply the 10-year ASCVD risk estimator and engage in a clinician-patient risk discussion before initiating

For primary prevention in adults >75 years, guidelines emphasize individualized clinician-patient risk discussion weighing ASCVD risk, comorbidities, and potential drug interactions before initiating statin therapy.

A patient with CKD stage 4 (eGFR 20 mL/min) requires statin therapy. Which statin requires the most significant dose adjustment or avoidance in this population?

Answer: Rosuvastatin

Rosuvastatin is significantly renally eliminated; the maximum recommended dose is 10 mg/day in patients with severe renal impairment (eGFR <30 mL/min) not on dialysis.

Which statin is the ONLY one specifically studied and approved for use in pediatric patients as young as 8 years of age with heterozygous familial hypercholesterolemia?

Answer: Pravastatin

Pravastatin has the most extensive pediatric safety data and is FDA-approved for children as young as 8 years with HeFH.

Diabetogenic risk associated with statin therapy is best characterized by which statement?

Answer: The relative risk increase of new-onset diabetes with statins is modest (~10%), with greatest risk in those already at metabolic risk

Statins confer approximately a 10–12% relative increase in new-onset T2DM risk, largely in patients with pre-existing risk factors (metabolic syndrome, impaired fasting glucose), but cardiovascular benefits far outweigh this risk in most patients.

In a patient who has experienced verified statin-induced myopathy with one statin, the most evidence-based rechallenging strategy is:

Answer: Switch to a different statin at the lowest available dose after CK normalization and muscle symptom resolution

Guidelines recommend rechallenging with a different statin (preferably one with lower myopathy risk such as rosuvastatin, pravastatin, or fluvastatin) at the lowest available dose after symptoms and CK normalize.