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Blood Cholesterol

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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)

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