Lipid Lowering Agents – Statins are Best
A Guideline To Lipid Lowering Agents
Treatment guidelines for lowering cholesterol levels have recently been updated and recommendations for multi-drug regimens have decreased. In long-term care there has been a shift in focus towards improving outcomes, and away from focusing on numbers or goals (i.e., goal LDL<60). Most of our residents have multiple co-morbidities and require treatment with a lipid lowering medication to reduce their risk of future events. Typically this includes treatment with a statin, examples include: atorvastatin, simvastatin, pravastatin, lovastatin, fluvastatin, and rosuvastatin. However, some residents will also have orders for additional medications which may include: niacin (OTC or Niaspan®), fenofibrate (Tricor®, Lofibra®), gemfibrozil (Lopid®), or ezetimibe (Zetia®).
Evidence indicates lipid lowering achieved with statin therapy protects against cardiovascular events more than any other medication option. Adding additional medications to a statin does not reduce future cardiac risks. The FDA has rescinded approval of niacin and fibrate derivatives in combination with statins after reviewing several trials, including AIM-HIGH and HPS2-THRIVE. The FDA concluded that “scientific evidence no longer supports the conclusion that a drug-induced reduction in triglyceride levels and/or increase in HDL-cholesterol levels in statin treated patients results in a reduction in the risk of cardiovascular events.” Ezetimibe was denied expanded indications for reducing mortality and morbidity by the FDA in 2015 utilizing data from the IMPROVE-IT Trial.
When appropriate, reviewing non-statin lipid lowering medications for discontinuation will decrease pill burden, potential side effects, and the risk for significant drug interactions. Do you have a resident or patient in mind that is taking one of these non-statin medications? Reach out to your Alixa Clinical Pharmacist during their next visit to discuss medications used to treat lipids.
References: 1. PL Detail-Document, Non-Statin Lipid-Lowering Agents. Pharmacist’s Letter/Prescriber’s Letter. July 2015. 2. UpToDate – www.uptodate.com. Accessed 6/13/2016.
This article was originally published in our monthly issue of From the Front Lines – a monthly publication that shares best practices and medication-related challenges faced by “front line” staff in long-term care and post-acute (LTCPAC) facilities.