90
Management
4.2.10. Approach to Patients With Elevated Lp(a)
COR LOE
Recommendations
1 B-NR
1. In all individuals with elevated Lp(a) (≥125 nmol/L or ≥50
mg/dL), optimal early control of modifiable cardiovascular
risk factors is recommended to reduce ASCVD risk.
1 B-R
2. In individuals with clinical ASCVD and elevated Lp(a) who
have not achieved LDL-C and non–HDL-C treatment goals
on maximally tolerated statin therapy, the addition of a PCSK9
mAb with proven cardiovascular benefit is recommended to
achieve treatment goals and reduce ASCVD risk.
4.2.11. Management of Statin-Attributed Muscle Symptoms
COR LOE
Recommendations
1 C-LD
1. In adults with statin-attributed muscle symptoms, assessment
should include evaluation for secondary causes (Table 24),
and in those with severe myalgias or weakness, objective
clinical measures of muscle strength and measurement of CK
are recommended to assess severity of the condition.
1 B-R
2. In adults with statin-attributed muscle symptoms, the
clinician-patient discussion should acknowledge patient
side effect concerns, inform the patient of the heightened
ASCVD risk associated with statin discontinuation, and
provide alternative treatment options to reduce ASCVD risk.
1 B-R
3. In adults with clinical ASCVD who experience statin-
attributed muscle symptoms on the recommended intensity
of statin therapy (secondary causes excluded) and are unable
to achieve recommended treatment goals, use of a reduced
statin dose (if tolerable) and the addition of bempedoic acid,
ezetimibe, or a PCSK9 mAb, alone or in combination, are
recommended to lower LDL-C and reduce ASCVD risk.
1 B-R
4. In adults without a history of clinical ASCVD who experience
statin-attributed muscle symptoms on the recommended
intensity of statin therapy (secondary causes excluded) and
are at high ASCVD risk based on a PREVENT-ASCVD
equation of ≥10% or a CAC score ≥300 AU, or women >65
years of age or men >60 years of age with diabetes, the addition
of bempedoic acid and/or ezetimibe is/are indicated to lower
LDL-C to <70 mg/dL (1.8 mmol/L) and non–HDL-C
<100 mg/dL (2.6 mmol/L) and to reduce ASCVD risk.
