3
7. Coronary artery calcium (CAC) scoring in men at least 40 years of
age and women at least 45 years of age can improve risk assessment
and guide LDL-C and non–HDL-C goals. Both the absolute amount
of CAC and the corresponding standardized percentile (currently
based on age, sex, and race) have prognostic importance and help to
reclassify risk in adults.
8. LDL-lowering therapy is recommended for primary prevention in
adults aged 40 to 75 years with diabetes, chronic kidney disease
stage 3 or 4, or human immunodeficiency virus, regardless of LDL-C
level. After age 75 years, LDL-C–lowering pharmacotherapy can
be considered in conjunction with lifestyle interventions to reduce
ASCVD risk.
9. In secondary prevention, a goal of LDL-C <55 mg/dL (1.4 mmol/L)
and non–HDL-C <85 mg/dL (2.2 mmol/L) is recommended for those
at very high risk of ASCVD events. Although a smaller number of
patients with ASCVD not at very high risk have an LDL-C goal of
at least <70 mg/dL, the majority of those with a history of ASCVD
events will likely qualify for an LDL-C goal of <55 mg/dL.
10. In patients with persistently elevated TG, statin therapy remains the
foundation of pharmacotherapy as an adjunct to lifestyle intervention
to reduce ASCVD risk. Treatment for prevention of pancreatitis may
also include TG-lowering therapies, especially in individuals with TG
levels ≥1000 mg/dL (11.3 mmol/L).
