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4.4.3. Monitoring in Response to LDL-C–Lowering Therapy
COR LOE
Recommendation
I A 1. Adherence to changes in lifestyle and effects of LDL-C–
lowering medication should be assessed by measurement of
fasting lipids and appropriate safety indicators 4 to 12 weeks
after statin initiation or dose adjustment and every 3 to 12
months thereafter based on need to assess adherence or safety.
4.4.4. Primary Prevention in Other Age Groups
COR LOE
Recommendations
4.4.4.1. Older Adults
Additional recommendations for adults >75 years of age are included in Section 4.1.
(Secondary ASCVD Prevention) and Section 4.3. (Diabetes Mellitus in Adults).
IIb B-R 1. In adults 75 years of age or older with an LDL-C level of 70
to 189 mg/dL (1.7 to 4.8 mmol/L), initiating a moderate-
intensity statin may be reasonable.
IIb B-R 2. In adults 75 years of age or older, it may be reasonable to
stop statin therapy when functional decline (physical or
cognitive), multimorbidity, frailty, or reduced life-expectancy
limits the potential benefits of statin therapy.
IIb B-R 3. In adults 76 to 80 years of age with an LDL-C level of 70
to 189 mg/dL (1.7 to 4.8 mmol/L), it may be reasonable to
measure CAC to reclassify those with a CAC score of zero to
avoid statin therapy.
4.4.4.2. Children and Adolescents
I A 1. In children and adolescents with lipid disorders related to
obesity, it is recommended to intensify lifestyle therapy,
including moderate caloric restriction and regular aerobic
physical activity.
I B-NR 2. In children and adolescents with lipid abnormalities, lifestyle
counseling is beneficial for lowering LDL-C.
IIa B-R 3. In children and adolescents 10 years of age or older with
an LDL-C level persistently 190 mg/dL (≥4.9 mmol/L) or
higher or 160 mg/dL (≥4.1 mmol/L) or higher with a clinical
presentation consistent with FH (see Section 4.2) and who
do not respond adequately with 3 to 6 months of lifestyle
therapy, it is reasonable to initiate statin therapy.
IIa B-NR 4. In children and adolescents with a family history of either
early CVD
a
or significant hypercholesterolemia,
b
it is
reasonable to measure a fasting or nonfasting lipoprotein
profile as early as age 2 years to detect FH or rare forms of
hypercholesterolemia.
