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Blood Cholesterol

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7 Figure 1. Secondary Prevention in Patients With Clinical ASCVD Clinical ASCVD High-intensity statin (Goal: ↓ LDL-C ≥50%) (Class I) Dashed arrow indicates RCT-supported efficacy but is less cost effective. Clinical ASCVD consists of acute coronary syndrome (ACS), those with history of myocardial infarction (MI), stable or unstable angina or coronary other arterial revascularization, stroke, transient ischemic attack (TIA), or peripheral artery disease (PAD) including aortic aneurysm, all of atherosclerotic origin. Very high-risk includes a history of multiple major ASCVD events or 1 major ASCVD event and multiple high-risk conditions (Table 2). Healthy Lifestyle ASCVD not at very high-risk* Very high-risk* ASCVD Age ≤75 y Age >75 y If high- intensity statin not tolerated, use moderate- intensity statin (Class I) If on maximal statin therapy and LDL-C ≥70 mg/ dL (≥1.8 mmol/L), adding ezetimibe may be reasonable (Class IIb) Initiation of moderate- or high- intensity statin is reasonable (Class IIa) Continuation of high-intensity statin is reasonable (Class IIa) High-intensity or maximal statin (Class I) If on maximal statin and LDL-C ≥70 (≥1.8 mmol/L), adding ezetimibe is reasonable (Class IIa) If PCSK9-I is considered, add ezetimibe to maximal statin before adding PCSK9-I (Class I) If on clinically judged maximal LDL-C lowering therapy and LDL-C ≥100 mg/dL (≥2.6 mmol/L), adding PCSK9-I is reasonable (Class IIa)

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