When it comes to prescribing statin drugs, doctors now have two different options. The purpose of each is to lower LDL-C and reduce cardiovascular events. These options are:
- Adjust the patient’s dose of statin until you reach a predetermined optimal blood level of LDL-cholesterol (<70).
- Prescribe a “fixed dose” of statin according to the patient’s risk profile
In other words, the doctor can prescribe a varying dose of statin until the patient’s LDL-C is 70 or less, or prescribe a fixed dose and intensity of a statin based on the patient’s history of events and co-morbidities and not worry about checking the cholesterol panel. I know which would be easier and less time consuming for the doctor, and that’s the fixed dose/intensity option. With this method, you don’t measure the cholesterol, and rely of the evidence produced after rigorous, diligent investigation of what drug and dose works best. This is predetermined by trial and error.
Both methods work, and both have advocates and detractors. “The American Heart Association and the American College of Cardiology both recommend the fixed-dose, risk-profile-based approach to cholesterol lowering rather than the treat-to-target strategy.”
Thus, the prescribing of high intensity statin therapy (rosuvastatin [Crestor 20-40mg] or atorvastatin [Lipitor 40-80 mg]) is recommended for most patients with presumed or known coronary artery disease. “The stated rationale was that the fixed-dose approach is effective and simplifies protocols.”
Dr. G’s Opinion: It’s the statin, not the protocol, that benefits patients. As long as you get the patient to take a statin, you’re helping him to live longer and have less CV events regardless of the dosing protocol. Our Arizona family doctor is a fixed-dose advocate. When we first saw him, he changed us from low intensity Simvastatin to rosuvastatin and never measured our cholesterol. Now I understand why!
Reference: Guthmann R, Korte A, Martin R. Target LDL-C Level or Fixed-Dose Treatment for ASCVD. Am Fam Phys 2026 February;113(2):183-184.
