3
Diagnosis
2. High Blood Cholesterol and ASCVD
2.1. Measurements of LDL-C and Non–HDL-C
COR LOE
Recommendations
I B-NR 1. In adults who are 20 years of age or older and not on lipid-
lowering therapy, measurement of either a fasting or a nonfasting
plasma lipid profile is effective in estimating ASCVD risk and
documenting baseline LDL-C.
I B-NR 2. In adults who are 20 years of age or older and in whom an
initial nonfasting lipid profile reveals a triglycerides level of
400 mg/dL (≥4.5 mmol/L) or higher, a repeat lipid profile in
the fasting state should be performed for assessment of fasting
triglyceride levels and baseline LDL-C.
IIa C-LD 3. For patients with an LDL-C level less than 70 mg/dL (<1.8
mmol/L), measurement of direct LDL-C or modified LDL-C
estimate is reasonable to improve accuracy over the Friedewald
formula.
IIa C-LD 4. In adults who are 20 years of age or older and without
a personal history of ASCVD but with a family history of
premature ASCVD or genetic hyperlipidemia, measurement of
a fasting plasma lipid profile is reasonable as part of an initial
evaluation to aid in the understanding and identification of
familial lipid disorders.
3. Therapeutic Modalities
3.1. Lipid-Lowering Drugs
➤ Among lipid-lowering drugs, statins are the cornerstone of therapy, in
addition to healthy lifestyle interventions. Other LDL-lowering drugs
include ezetimibe, bile acid sequestrants, and PCSK9 inhibitors.
➤ Triglyceride-lowering drugs are fibrates and niacin; they have a mild
LDL-lowering action, but RCTs do not support their use as add-on
drugs to statin therapy.
3.1.1. Statin Therapy
➤ The intensity of statin therapy is divided into 3 categories: high-
intensity, moderate-intensity, and low-intensity. High-intensity statin
therapy typically lowers LDL-C levels by ≥50%, moderate-intensity
statin therapy by 30% to 49%, and low-intensity statin therapy by
<30% (Table 1).
