Statin therapy in 2023

In this episode, pharmacist prescriber Linda Bryant discusses statin use in New Zealand today, how it has changed and its future place.

Topics

intro
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What is happening in NZ with respect to IHD morbidity and mortality?
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How are we doing in minority populations?
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Cardiovascular risk management has changed a lot over the last 20 years
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Who should get a statin? – Primary Prevention
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Who should get a statin? – Secondary Prevention
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Who should get a statin? – Familial hypercholesterolemia
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Who should get a statin? – Other special conditions
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What are our targets (LDL)?
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What are our targets (ratios, CV risk)?
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Empowering patients – tools to highlight benefits.
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Starting a statin – choice and titration.
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Muscle aches- what now?
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Other options if a statin isn’t suitable?
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When to consider genetics?
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What’s new on the horizon?
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Take-home messages
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Take home messages

Review your approach to CV risk – and consider lowering your threshold to recommending and initiating statins, especially in younger people with risk factors, including high LDL
Although not RCT’s there is good evidence that lowering LDL is a key – down to 1.4 mmol/L in secondary prevention, and high risk primary prevention – down to 1.8 mmol/L
Whether due to the pleiotropic effects or the LDL concentration itself – if you are going to treat, then treat definitely – don’t be scared of atorvastatin 80mg, and use rosuvastatin as second line
Explain to the person how cholesterol is involved in causing a myocardial infarction or stroke, and then use NNT, smiley faces on the absolute CV risk calculator, or heart age to engage them in treatment – simple and brief is OK
There are more medicines that we need – and hopefully we will have them soon

Resources

My Heart Check National Heart Foundation of New Zealand
Risk Calcolator The Absolute CVD Risk/Benefit Calculator
New Zealand Heart Risk Assessment Mōhio - public preview
NHS England statin intolerance pathway NICE guidance and the quality standards
Lipid treatment targets in individuals at high cardiovascular risk Cardiac Society of Australia and New Zealand

Presenter

Linda Bryant

Pharmacist Prescriber

Linda works at Newtown Union Health Service and Porirua Union and Community Health Service. She is an Honorary Academic in the Department of General Practice and Primary Health Care at the University of Auckland and has over twenty year’s experience teaching postgraduate clinical pharmacy.

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The Goodfellow Unit podcast is funded in part by the Royal New Zealand College of General Practitioners.