Cardiovascular

Statins and cholesterol: who gets which intensity

The four groups that benefit from a statin, how to tell moderate from high intensity, the safety checks, and the drug interactions to remember.

9 min read·core·

Reviewed by a licensed nurse · 25 October 2026

Statin intensity

Intensity	LDL lowering	Examples
High	About 50 percent or more	Atorvastatin 40 to 80 mg, rosuvastatin 20 to 40 mg
Moderate	About 30 to 49 percent	Atorvastatin 10 to 20 mg, rosuvastatin 5 to 10 mg, simvastatin 20 to 40 mg, pravastatin 40 to 80 mg, lovastatin 40 mg, pitavastatin 1 to 4 mg
Low	Under 30 percent	Simvastatin 10 mg, pravastatin 10 to 20 mg, lovastatin 20 mg

Doses are from the 2018 ACC/AHA cholesterol guideline.

01
Clinical atherosclerotic disease
Prior heart attack, stroke, peripheral artery disease or similar. High-intensity statin if age 75 or under. If over 75, moderate or high intensity after discussing it.
02
LDL 190 mg/dL or higher
High-intensity statin without calculating risk. Consider familial hypercholesterolemia.
03
Diabetes, age 40 to 75
Moderate-intensity statin. High intensity if there are several additional risk factors.
04
Primary prevention, age 40 to 75, LDL 70 to 189
Estimate 10-year risk. If 7.5 percent or higher, a moderate-intensity statin after a risk discussion. Borderline risk (5 to 7.4 percent) depends on risk-enhancing factors.

·Measure a baseline lipid panel, and recheck about 4 to 12 weeks after starting to check response and adherence.
·Statins are contraindicated in pregnancy. Stop them when pregnancy is planned or confirmed.
·Muscle pain with weakness: check CK, and stop the drug if rhabdomyolysis is suspected.
·Check liver enzymes at baseline. Routine repeat testing is not recommended unless symptoms suggest a problem.
·Counsel on lifestyle at the same time. A statin is added to it, not a substitute for it.

Check yourself

1. A 62-year-old has had a myocardial infarction. Which statin plan is best?
2. A 50-year-old with type 2 diabetes, no cardiovascular disease and LDL 110 mg/dL. Which is the guideline-based minimum?
3. A patient takes amlodipine and needs a statin. Which choice avoids a dose limit?