January 2019 Pharmacy Update
2018 Cholesterol Guideline Update
As you may be aware, there were several updates to the cholesterol guidelines in 2018. For your reference, please see the links below:
- Highlights of the 2018 Guidelines on the Management of Blood Cholesterol
Includes algorithms for primary prevention and secondary prevention
- Top Ten Things to Know: 2018 Guideline on the Management of Blood Cholesterol
Includes key recommendations from the full 2018 guideline update
In addition, please see below for some commonly asked questions and answers regarding statin use in managing cholesterol levels:
What do I do if my patient experiences muscle pain while on a statin?
- Thorough assessment of symptoms is recommended. Rule out non-statin causes and predisposing factors.
- For statin-associated side effects that are not severe:
- Reassess and rechallenge by modifying the dose, trying another statin, or combining with non-statin therapy with a lower dose
- If symptoms persist despite rechallenge, recommend non-statin therapy (ezetimibe) after weighing benefits and risks
- For severe statin-associated muscle symptoms:
- Check CK (creatine kinase) and liver function tests to identify any signs suggesting hepatotoxicity. Consider additional testing (e.g. physical exam) if symptoms persist.
- Can recommend non-statin therapy after weighing benefits and risk
- Do not restart statin if rhabdomyolysis is confirmed
Okay, I started my patient on a statin! What should I monitor and when?
- Check fasting (preferred) lipid panel 4-12 weeks after starting/changing statin and lifestyle interventions. Check every 3-12 months thereafter as needed.
- Consider checking liver function tests at baseline to guide statin therapy or if needed to check for other risk factors (e.g. drugs that may interact)
- Monitor for medication adherence at every visit
- Routine measurements of CK and transaminase levels are not recommended