, 1 month), re-challenge with same or a different statin or lower dose, and if that fails, a trial of intermittent (nondaily) dosing Intensified patient care (e.g., phone calls, emails, patient education, drug regimen simplification) may improve adherence to lipid-lowering medications Statin doses listed as moderate are equivalent to moderate intensity; statin doses listed as high are equivalent to high intensity Abbreviations: BID: twice per day; mg: milligrams; XL: sustained release Sidebar 2: Higher Risk CVD Patients MI or ACS in past 12 months; or Recurrent ACS, MI, or CVA; or Known CVD (see Sidebar 1) and any of the following: currently smoking, DM, PAD, or CABG/PCI VA/DoD CPG for the Management of Dyslipidemia for Cardiovascular Risk Reduction Provider Summary Statin and Non-statin Pharmacologic Agents Table 1. Summary of Statin and Non-statin Pharmacologic Agents* Drug Category Dose Major Drug Interactions Adverse Drug Reactions Notes Statins Atorvastatin once daily Since statins vary in their metabolic pathway, refer to product labeling for drug-drug interactions and statin dose limits Risk for myalgia, myopathy and, very rarely, rhabdomyolysis. Other risks include diabetes, LFT elevations, and asymptomatic CK elevations. First line therapy for primary or secondary prevention of CVD Rosuvastatin 5 40 mg once daily Simvastatin 5 40 mg once daily Lovastatin once daily Pravastatin once daily Fluvastatin 20 80 mg per day Pitavastatin 1 4 mg once daily Cholesterol absorption inhibitors Ezetimibe 10 mg once daily Increased incidence of transaminase elevation >3x ULN when combined with statins versus statins respectively) Generally well tolerated Benefit for reducing non- fatal CV events in secondary prevention patients in addition to statin inhibitors Alirocumab 75 mg once every 2 weeks OR 300 mg once every 4 weeks Max: 150 mg every 2 weeks No known significant interactions Injection site reactions (3 7%). 