42
Management
Figure 6. Primary Prevention in Adults 30 to 79 Years
Without ASCVD
NO
NO
YES
YES
YES
LDL-C 160–189
mg/dL or 30-y
ASCVD risk ≥10%?
Low 10-y Risk
(<3%)
1
Initiate statin
therapy
1
Health
behavior
counseling
2a
Start moderate -
intensity statin
Goal: ≥30%
LDL-C reduction;
LDL-C <100 mg/dL
and non–HDL-C
<130 mg/dL
2a
Start moderate -
intensity statin
Goal: ≥30%
LDL-C reduction;
LDL-C <100 mg/dL
and non–HDL-C
<130 mg/dL
Decide to
start LLT?
Borderline 10-y Risk
(3%–<5%)
1
Health behavior
counseling
1
Have benefit-risk
discussion
1
Calculate 10-y and
30-y ASCVD risk using
PREVENT-ASCVD
AND
Adults with LDL-C
70–189 mg/dL
ASCVD indicates atherosclerotic cardiovascular disease; CAC, coronary
artery calcium; HDL-C, high-density lipoprotein-cholesterol; LDL-C, low-
density lipoprotein-cholesterol; and LLT, lipid-lowering therapy.
Adapted with permission from Grundy at al. Copyright © 2018 American
Heart Association, Inc. and American College of Cardiology Foundation.
