TREATMENT PLAN, CONTRAINDICATIONS – FOR STATINS

TREATMENT PLAN 

Primary care Interventions:

• Lifestyle modifications
• Statins: Atorvastatin 20mg or Rosuvastatin 10mg
• Second line: Ezetimibe
• Aim of drug treatment: 50% decrease in LDL concentration – When we need to refer: – Children <15 years
• Homozygous forms
• Treatment failure

-Additional options that secondary care provide:

• Bempedoic acid (with ezetimibe)
• Fibrates (secondary care)
• Inclisiran (with diet modifications)
• Refer high-risk Adult Heterozygous patients: e.g., established CVD & ≥2 CVD risk      factors, family history of premature CVD < 60 years old & a 1^st-degree relative

Follow-up:

• 2-3 months: lipids and LFTs
• If <50% reduction: – Increase statin dose or Add ezetimibe or Change to simvastatin

80mg

• 12-month/annual review: Check adherence, give advice, fasting, lipids, blood pressure,

HBA1C, U&e, monitor for side effects

CONTRAINDICATIONS – FOR STATINS 

• Active liver disease
• Transaminases >3x upper limit
• CK >5x upper limit
• Pregnancy/breastfeeding
• Family/personal history of muscle disorders – Specifically For rosuvastatin:
• CKD stage 4-5
• Asian ethnicity with CKD 3-4
• Hereditary muscle disorders
• Alcohol misuse.