Statin Therapy Case Study: Managing Cardiovascular Risks

This case study examines the use of statin therapy in managing cardiovascular risk in a 55-year-old diabetic patient with high LDL cholesterol. It identifies the patient's risk category according to atherosclerotic cardiovascular disease guidelines and proposes statin drug therapy, including specific drugs like lovastatin and atorvastatin, to lower cholesterol levels by inhibiting HMG-CoA reductase. The study outlines methods for monitoring treatment effectiveness through fasting lipid profile tests and scintigraphic assessments, while also addressing potential adverse effects such as increased liver enzymes, muscle pain (myositis, rhabdomyolysis), and cognitive decline. The recheck results indicate improvement, but the patient still faces cardiovascular risks, leading to a discussion of alternative lipid-lowering therapies like ezetimibe and fibrates. Desklib offers a wealth of similar case studies and solved assignments for students seeking academic support.

Running head: STATIN CASE STUDY
Question Answers on Case Study
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Author Note

1STATIN CASE STUDY
Answer 1
Statins are also called HMG-CoA reductase and show significant effects in reducing
cardiovascular diseases and associated mortality among people, who are at an increased
susceptibility of getting affected. The atherosclerotic cardiovascular disease guidelines identified
4 statin benefit groups, based on the likelihood of a person of getting affected with
cardiovascular disorder (Thanassoulis et al., 2016). The 4 statin benefit groups are the following-
 Individuals suffering from clinical atherosclerotic cardiovascular disease, such as, acute
coronary syndrome, or history of myocardial infarction, anjina, stroke, peripheral arterial
disease, or TIA.
 Individuals of the age 40-75 years suffering from diabetes and with LDL-C levels in the
range 7.89 mg/dL (Ridker et al., 2012).
 Individuals with low-density lipoprotein cholesterol levels ≥190 mg/dL.
 People aged 40-75 years, without diabetes or ASCVD, with LDL-C 70-189 mg/dL, and
with a 10 year risk of 7.5% ASCVD.
An analysis of the case scenario suggests that the patient is 55 years old, diabetic with 7.2%
HbA1c levels, and has high cholesterol LDL-162 mg/dL. Thus, he falls under the two risks
namely, those with low-density lipoprotein cholesterol levels ≥190 mg/dL and suffering from
diabetes. Therefore, it can be stated that the patient is at a higher risk of developing
atherosclerotic cardiovascular disorders in near future.
Answer 2
The statin drug therapy would be prescribed for this patient, in order to reduce the high
risk of cardiovascular disease. it will act as an effective treatment in treating elevated risk of the

2STATIN CASE STUDY
disorder. Common drugs that can be used for statin therapy include lovastatin, atorvastatin,
fluvastatin, and simavastatin. The statin drugs will help in lowering the level of cholesterol
present in blood, by reducing cholesterol production from the liver.
Statin drugs will act on the enzyme hydroxy-methylglutaryl coenzyme A reductase, and
block its action, thereby preventing cholesterol formation (Stone et al., 2014). Atherosclerosis
usually develops due to formation of cholesterol containing flux inside arteries. These plaques
create blocks in the artery, which in turn reduces blood flow to the cells and tissues. Reduction in
cholesterol production will slow plaque formation and reduce the size of plaques. This in turn
will help in preventing complications of atherosclerosis. To prevent high cholesterol levels, 20-
80 mg of statin will be administered once daily, depending on the generic names (Ridker et al.,
2012). The maximum dosage that can be administered is 80 mg, which will be given twice a day
in the form of 40mg capsules.
Answer 3
There are several tests that can be conducted in order to identify therapeutic effectiveness
of the statin drug therapy. In order to monitor success of the treatment, an initial fasting lipid
profile test should be conducted. It will help in giving an estimate of the total lipid profile, by
measuring the amount of high density and low density lipoprotein. This should be followed by
conduction of lipid tests at an interval of 4-12 weeks, followed by every 3-7 months. Laboratory
results will help in assessing authority to the drug therapy. A reduction in LDL-C Buy an
average 30-50% will indicate effectiveness of the statin drugs.
The patient should also be evaluated for the need of increasing dosage intensity of statin,
if the cholesterol levels do not get reduced. The baseline serum lipase level will also help in

3STATIN CASE STUDY
predicting risk of coronary disorders. Conduction of a scintigraphic assessment for myocardial
perfusion will also help in assessing risk of coronary events. Conduction of serum lipid test will
facilitate identifying the need of decreasing statin dose if two consecutive tests give an LDL
value less than 40.
Answer 4
Although HMG-CoA reductase inhibitor or statin are the best recommended drugs in
order to reduce risks of cardiovascular disease and lower the level of cholesterol in the blood,
several clinical trials have shown that statin may exert adverse effects upon their administration.
The most common adverse side effects that can be observed in the patient on administration of
the drug therapy are increased liver enzymes, muscular problems, bleeding stroke, pancreatic
dysfunction, and neuropathy.
Muscle pain is one problem that can arise in the patient. The patient might report
symptoms of muscle inflammation, commonly termed as myositis, or destruction of the muscle
cells, known as rhabdomyolysis (Gagne et al., 2014). This can result in negative impacts on the
kidney. The patient will be at 10 times increased likelihood of developing rhabdomyolysis upon
administration of cerivastatin. Another possible adverse effect is a decline in cognitive abilities.
Prolonged use of the statin drug therapy might result in memory loss and the patient might lose
the power to think and reason. It can also result in confusion and forgetfulness. These cognitive
problems are second to muscular disorders. Owing to the fact that the brain tissue shares greater
mitochondrial vulnerability with muscles, both have a high metabolic demand (Naci et al., 2013).
This might result in changing the drug therapy.
Answer 5

4STATIN CASE STUDY
On a recheck, 100mg/dL LDL levels and 38 mg/dL HDL levels indicate that his
condition has improved from the previous state. However, there is still a risk factor for
developing cardiovascular disease. High effectiveness of statin can be correlated with the
symptoms of muscle pain reported by the patient (Hoffman et al., 2012). The pain can be minor
in the form of stiffness or soreness. A physical examination and blood test is required to
determine effect of statin medication on the pain. On achieving positive results, statin
administration might be stopped, for improving the symptoms. The patient will be advised to
stop performing vigorous physical exercise. Use of pain relievers will also be prevented.
Furthermore, on symptoms of severe pain, statin drugs might be replaced with lipid lowering
therapies or selective cholesterol absorption inhibitors. The latter prevents absorption of
cholesterol in the intestine. Research studies have proved its effectiveness in lowering LDL
cholesterol (Bellosta & Corsini, 2012).
It also plays a major role on lowering the amount of triglycerides and elevating HDL
cholesterol. Most common selective cholesterol absorption inhibitor that can be administered is
ezetimibe (Cannon et al., 2015). On the other hand, lipid lowering therapies rely on use of
fibrates that lower the amount of triglycerides and increase HDL levels. Common fibrates that
can be used are colifibrate and gemfibrozil. They affect production of blood fats and closely
monitor functioning of the liver. However, they have not been proved effective in lowering LDL
cholesterol levels.

5STATIN CASE STUDY
Reference
Bellosta, S., & Corsini, A. (2012). Statin drug interactions and related adverse reactions. Expert
opinion on drug safety, 11(6), 933-946.
Cannon, C. P., Blazing, M. A., Giugliano, R. P., McCagg, A., White, J. A., Theroux, P., ... & De
Ferrari, G. M. (2015). Ezetimibe added to statin therapy after acute coronary
syndromes. New England Journal of Medicine, 372(25), 2387-2397.
Gagne, J. J., Choudhry, N. K., Kesselheim, A. S., Polinski, J. M., Hutchins, D., Matlin, O. S., ...
& Shrank, W. H. (2014). Comparative effectiveness of generic and brand-name statins on
patient outcomes: a cohort study. Annals of internal medicine, 161(6), 400-407.
Hoffman, K. B., Kraus, C., Dimbil, M., & Golomb, B. A. (2012). A survey of the FDA's AERS
database regarding muscle and tendon adverse events linked to the statin drug class. PloS
one, 7(8), e42866.
Naci, H., Brugts, J. J., Fleurence, R., Tsoi, B., Toor, H., & Ades, A. E. (2013). Comparative
benefits of statins in the primary and secondary prevention of major coronary events and
all-cause mortality: a network meta-analysis of placebo-controlled and active-comparator
trials. European journal of preventive cardiology, 20(4), 641-657.
Ridker, P. M., Pradhan, A., MacFadyen, J. G., Libby, P., & Glynn, R. J. (2012). Cardiovascular
benefits and diabetes risks of statin therapy in primary prevention: an analysis from the
JUPITER trial. The Lancet, 380(9841), 565-571.

6STATIN CASE STUDY
Ridker, P. M., Pradhan, A., MacFadyen, J. G., Libby, P., & Glynn, R. J. (2012). Cardiovascular
benefits and diabetes risks of statin therapy in primary prevention: an analysis from the
JUPITER trial. The Lancet, 380(9841), 565-571.
Stone, N. J., Robinson, J. G., Lichtenstein, A. H., Merz, C. N. B., Blum, C. B., Eckel, R. H., ... &
McBride, P. (2014). 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. Journal of
the American College of Cardiology, 63(25 Part B), 2889-2934.
Thanassoulis, G., Williams, K., Altobelli, K. K., Pencina, M. J., Cannon, C. P., & Sniderman, A.
D. (2016). Individualized statin benefit for determining statin eligibility in the primary
prevention of cardiovascular disease. Circulation, CIRCULATIONAHA-115.