Overview

• Experts recommend starting primary and secondary prevention patients on maximal-dose rosuvastatin or atorvastatin instead of low-dose initiation and titration.
• Upfront high-dose statin therapy improves long-term adherence since most patients remain on their initial prescribed dose.
• Therapeutic lifestyle changes—such as smoking cessation, weight management and regular physical activity—are effective but underused, as 40% of U.S. adults have metabolic syndrome and only 21% meet daily exercise guidelines.
• Adjunctive agents such as ezetimibe and PCSK9 inhibitors should be added only for high-risk individuals who fail to meet LDL targets with statins alone.
• Adding icosapent ethyl to high-dose statins reduced major cardiovascular events by 25% in REDUCE-IT, with a number needed to treat of 21.