14
Diagnosis
4.4.2. Primary Prevention Adults 40 to 75 Years of Age With
LDL-C Levels 70 to 189 mg/dL (1.7 to 4.8 mmol/L)
COR LOE
Recommendations
I A 1. In adults at intermediate-risk, statin therapy reduces risk of
ASCVD, and in the context of a risk discussion, if a decision
is made for statin therapy, a moderate-intensity statin should
be recommended.
I A 2. In intermediate-risk patients, LDL-C levels should be
reduced by 30% or more, and for optimal ASCVD risk
reduction, especially in high-risk patients, levels should be
reduced by 50% or more.
I B-NR
3. For the primary prevention of clinical ASCVD
a
in adults
40 to 75 years of age without diabetes mellitus and with an
LDL-C level of 70 to 189 mg/dL (1.7 to 4.8 mmol/L), the
10-year ASCVD risk of a first "hard" ASCVD event (fatal
and nonfatal MI or stroke) should be estimated by using
the race- and sex-specific pooled cohort equation (PCE),
and adults should be categorized as being at low risk (<5%),
borderline risk (5% to <7.5%), intermediate-risk (≥7.5% to
<20%), and high-risk (≥20%).
I B-NR 4. Clinicians and patients should engage in a risk discussion
that considers risk factors, adherence to healthy lifestyle,
the potential for ASCVD risk-reduction benefits, and the
potential for adverse effects and drug-drug interactions, as
well as patient preferences, for an individualized treatment
decision.
IIa B-R 5. In intermediate-risk adults, risk-enhancing factors favor
initiation or intensification of statin therapy.
IIa B-NR 6. In intermediate-risk or selected borderline-risk adults, if the
decision about statin use remains uncertain, it is reasonable
to use a CAC score in the decision to withhold, postpone or
initiate statin therapy.
IIa B-NR 7. In intermediate-risk adults or selected borderline-risk adults
in whom a CAC score is measured for the purpose of making
a treatment decision, AND
• If the coronary calcium score is zero, it is reasonable to
withhold statin therapy and reassess in 5 to 10 years, as
long as higher risk conditions are absent (diabetes mellitus,
family history of premature CHD, cigarette smoking );
• If CAC score is 1 to 99, it is reasonable to initiate statin
therapy for patients ≥ 55 years of age;
• If CAC score is 100 or higher or in the 75th percentile or
higher, it is reasonable to initiate statin therapy.
