High dose statin should be last step in combo therapy link
Many patients have been lost to statins because of failure to avoid side effects at high doses.
My opinion is to use lowest dose first as there is a variability of response (as noted above).
Individualize therapy with goal of compliance being equally important to goal of LDLp < 750 to 1,000.
Adding low dose(1,000 mg) Slo-niacin or Endur-acin is very inexpensive and has additive effect of lowering LDLp better than higher dose of statin. If we are to treat earlier and for longer periods we need to use lowest effective dose at lowest price with least side effects.