2
Key Points
➤ In all individuals, emphasize a heart-healthy lifestyle across the life
course.
➤ In patients with clinical ASCVD, reduce low-density lipoprotein
cholesterol (LDL-C) with high-intensity statin therapy or maximally
tolerated statin therapy.
➤ In very high-risk ASCVD, use a LDL-C threshold of 70 mg/dL (1.8
mmol/L) to consider addition of nonstatins to statin therapy. Very
high-risk includes a history of multiple major ASCVD events or 1
major ASCVD event and multiple high-risk conditions.
➤ In patients with severe primary hypercholesterolemia (LDL-C level
≥190 mg/dL [≥4.9 mmol/L]), begin high-intensity statin therapy
without calculating 10-year ASCVD risk.
➤ In patients 40 to 75 years of age with diabetes mellitus and LDL-C
≥70 mg/dL (≥1.8 mmol/L), start moderate-intensity statin therapy
without calculating 10-year ASCVD risk.
➤ In adults 40 to 75 years of age evaluated for primary ASCVD
prevention, have a clinician-patient risk discussion before starting
statin therapy.
➤ In adults 40 to 75 years of age without diabetes mellitus and with
LDL-C levels ≥70 mg/dL (≥1.8 mmol/L), at a 10-year ASCVD risk of
≥7.5%, start a moderate-intensity statin if a discussion of treatment
options favors statin therapy.
➤ In adults 40 to 75 years of age without diabetes mellitus and 10-year
risk of 7.5% to 19.9% (intermediate risk), risk-enhancing factors favor
initiation of statin therapy.
➤ In adults 40 to 75 years of age without diabetes mellitus and with
LDL-C levels ≥70 mg/dL to 189 mg/dL (≥1.8–4.9 mmol/L), at a 10-
year ASCVD risk of ≥7.5% to 19.9%, if a decision about statin therapy
is uncertain, consider measuring coronary artery calcium (CAC).
➤ Assess adherence and percentage response to LDL-C–lowering
medications and lifestyle changes with repeat lipid measurement 4 to
12 weeks after statin initiation or dose adjustment, repeated every 3
to 12 months as needed.
1. Introduction
