12
Diagnosis
Figure 2. Primary Prevention
Diabetes mellitus and
ago 40-75y
Moderate-intensity
statin
(Class I)
Primary Prevention:
Assess ASCVD Risk in Each Group
Emphasize Adherence to Healthy Lifestyle
Age 0-19y
Lifestyle to prevent or
reduce
ASCVD risk
Diagnosis of Familial
Hypercholesterolemia
➜ statin
Age >75 y
Clinical assessment,
Risk discussion
If risk decision is uncertain:
Consider measuring CAC in selected adults:
CAC = zero (lowers risk; consider no statin unless diabetes, family
history of premature CHD or cigarette smoking is present)
CAC = 1-99 favors statin (especially after age 55)
CAC = 100+ and/or ≥75th percentile, initiate statin therapy
Risk discussion:
Emphasize
lifestyle to
reduce risk
factors
(Class I)
Risk discussion:
If risk enhancers
present then
risk discussion
regarding
moderate-intensity
statin therapy
(Class IIb)
LDL-C ≥190 mg/dL
(≥4.9 mmol/L)
No risk assessment;
high-intensity statin
(Class I)
Diabetes mellitus and
age 40-75y
Risk assessment to
consider high-intensity
statin
(Class IIa)
<5%
"Low risk"
Age 20-39y
Estimate lifetime risk to encourage
lifestyle to reduce ASCVD risk.
Consider statin if family history
premature ASCVD and LDL-C ≥160
mg/dL (≥4.1 mmol/L)
Age 40-75y and
LDL-C ≥70-<190
mg/dL (≥1.8-<4.9
mmol/L) without
diabetes mellitus
10-year ASCVD risk
percent begins risk
discussion
5%-<7.5%
"Borderline
Risk"
≥7.5%-<20%
"Intermediate
Risk"
≥20%
"High Risk"
Risk discussion:
If risk estimate
+ risk enhancers
favor statin, initiate
moderate-intensity
statin to reduce
LDL-C by 30%-49%
(Class I)
Risk discussion:
Initiate statin
to reduce
LDL-C ≥50%
(Class I)
