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Table 10. Very High-Risk* of Future ASCVD Events
Definition of Very High-Risk*
• History of multiple major ASCVD events
OR
• One major ASCVD event AND ≥2 high-risk conditions
Major ASCVD Events
• Recent ACS (within the past 12 mo)
• History of MI (other than recent ACS events listed above)
• History of ischemic stroke
• Symptomatic peripheral artery disease (history of claudication with ABI <0.85, or
previous revascularization or amputation)
High-Risk Conditions
• Age ≥65 y
• Familial hypercholesterolemia
†
• History of previous coronary artery bypass graft surgery or percutaneous coronary
intervention outside of the major ASCVD event(s)
• Diabetes
• Hypertension
• Chronic kidney disease (eGFR, 15–59 mL/min/1.73m
2
)
• Current tobacco smoking
• Persistently elevated LDL-C ≥100 mg/dL despite maximally tolerated statin therapy
and ezetimibe
• History of congestive heart failure
* Very high-risk includes a history of multiple major ASCVD events or 1 major ASCVD
event and multiple high-risk conditions.
†
Management of patients with familial hypercholesterolemia oen requires combination lipid
lowering therapy and referral to a lipid specialist, and possibly lipoprotein apheresis. Gidding
SS, et al. Circulation. 2015;132:2167-2192 and Goldberg AC J Clin Lipidol. 2011;5:S1-8.
Modified with permission from Grundy SM, et al. op. cit. Copyright 2019 American Heart
Association, Inc., and American College of Cardiolog y Foundation.
