Lipid Lowering Agents – Statins are Best

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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  The FDA has rescinded approval of niacin and fibrate derivatives in combination with statins after reviewing several trials, including AIM-HIGH and HPS2-THRIVE.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 –  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.

>>> From the Front Lines – July 2016 <<<