Regular checkups are needed while taking statins so adjustments can be made to the medication regimen, as needed. The American Heart Association/American College of Cardiology guidelines for the management of blood cholesterol recommend that physicians who prescribe statins should monitor adherence and response to statins following initiation and after dosage changes.1 Lipid measurements are recommended 4 to 12 weeks after the first dose, and repeated every 12 months as needed, or as often as every 3 months if goals are not met.1–4
Regular monitoring has been shown to improve adherence to statin therapy over time. Benner et al. conducted a retrospective cohort study of 19,422 participants in a managed care plan and analyzed the patterns and predictors of adherence to lipid-lowering therapy for up to three years.2 Patients receiving regular lipid monitoring and physician visits in the months after statin initiation were substantially more likely to be adherent in subsequent visits.
Routine monitoring is also important because statins increase the risk of diabetes in some patients, an effect that may vary by the statin type and dosage used.5 The effect is particularly true for those with metabolic syndrome and on high-dose statin therapy who were at higher baseline risk of diabetes before statins were initiated.6,7 The frequency of blood sugar monitoring depends on the population. Individuals with body mass index ≥30, fasting blood glucose ≥100 mg/dL, A1C >6.0%, or metabolic syndrome may need more frequent assessments.1 Routine measurement of liver function or creatine kinase is not recommended for all patients on statins by the 2018 guidelines but can be considered in the presence of concerning side effects. Creatine kinase measurement is recommended in the presence of severe muscle symptoms or objective muscle weakness. Liver function tests should be done regularly (frequency not specified) in patients taking statins who have chronic stable liver disease or in the presence of objective evidence of liver toxicity.
Regular visits can also be used to monitor and encourage efforts to modify lifestyle that are known to lower LDL-C, including weight loss, increased physical activity, and dietary modifications such as reduced intake of saturated fats. The 2018 guidelines also recommend that physicians discuss statin-associated side effects. Many patients who have side effects respond to a statin re-challenge with an alternate statin or revised dosing of the same statin.
Response to lifestyle changes and lipid-lowering therapy is measured by percent reduction in LDL compared with baseline.1 However, the threshold for the initiation of non-statins in individuals at very high risk of cardiovascular events is an LDL-C ≥70 mg/dL on maximal statin therapy.
References
- Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACCguideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol. 2019;73(24):e285-e350.
- Benner JS, Tierce JC, Ballantyne CM, et al. Follow-up lipid tests and physician visits are associated with improved adherence to statin therapy. Pharmacoeconomics. 2004;22 Suppl 3:13-23.
- Chiavaroli L, Nishi SK, Khan TA, et al. Portfolio dietary pattern and cardiovascular disease: asystematic review and meta-analysis of controlled trials. Prog Cardiovasc Dis. 2018;61(1):43-53.
- Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2889-2934.
- Navarese EP, Buffon A, Andreotti F, et al. Meta-analysis of impact of different types and doses of statins on new-onset diabetes mellitus. Am J Cardiol. 2013;111(8):1123-1130.
- Ridker PM, Pradhan A, MacFadyen JG, Libby P, Glynn RJ. Cardiovascular benefits and diabetes risks of statin therapy in primary prevention: an analysis from the JUPITER trial. Lancet. 2012;380(9841):565-571.
- Waters DD, Ho JE, Boekholdt SM, et al. Cardiovascular event reduction versus new-onset diabetes during atorvastatin therapy: effect of baseline risk factors for diabetes. J Am Coll Cardiol. 2013;61(2):148-152.
