Team 3 QICD Cholesterol Screening in Diabetes Guidelines

Diabetic Patient

LDL <100 (GOAL) LDL >100

Check FLP annuallyCheck FLP q6wksand titrate statin to

goal

1. ADA Standards of Medical Care 20102. ATP3 Guidelines 3. NCEP Guidelines4. Sathesivam S, Lecky B. Statin Induced Myopathy. BMJ 2008;337:a2286.5. Eckel R. Approach to the patient who is intolerant of statin therapy. J Clin Endocrinol Metab 2010; 95:2015-2022.

Frequently Asked Questions

1. What statin should I start with for someone who is newly diagnosed with hypercholesterolemia? Simvastatin

2. What is the starting dose of Simvastatin if someone is slightly above goal? 20 mg

3. What is the starting dose of Simvastatin if I would like at least a 45% decrease in LDL? 40 mg

4. Which statins are least associated with myopathy? Pravastatin, Rosuvastatin, and Fluvastatin

5. What statins are more potent than Simvastatin if someone is on the max dose of Simvastatin and still not at goal? Atorvastatin and Rosuvastatin

6. Why is controlling cholesterol so important? To prevent atherosclerosis!

Algorithm for Frequency of FLP measurement

Statin Approximate

Equivalent Dose

Percent Change from Baseline LDL

Initial dosing

Atorvastatin 10 mgLovastatin 40 mgPravastatin 40 mgSimvastatin 20 mg

-31 to -38% For a 30-40% reduction in LDL-C

Atorvastatin 20 mgLovastatin 80 mgRosuvastatin 5 mgSimvastatin 40 mg

-45 to -48% For a 45-50% reduction in LDL-C

Atorvastatin 40 mgRosuvastatin 10 mgSimvastatin 80 mg

-46 to -48% For a 50% reduction in LDL-C

Atorvastatin 80 mgRosuvastatin 20 mg

-51 to -52% For > 50% reduction in LDL-C (but will likely need to add

additional therapy)

Amy Egras, Pharm D