92
Management
Optional apoB goal
<70 mg/dL
1
Goal LDL-C <70 mg/dL
and non–HDL-C
<100 mg/dL
AND
1
Have benefit-risk
discussion, evaluate
secondary causes of
muscle symptoms, and
assess muscle strength
If severe myalgias or
muscle weakness,
measure creatine kinase
1
AND
2b
Goal LDL-C <100
mg/dL and non–HDL-C
<130 mg/dL
2b
If goal not achieved,
add ezetimibe and/or
bempedoic acid
2b
If initiation of nonstatin
therapy uncertain,
optional use of CAC
1
If goal not achieved,
add bempedoic acid
and/or ezetimibe or a
PCSK9 mAb
Statin-attributed muscle symptoms
(side effects on ≥2 statins, 1 at
lowest FDA-approved dose)
Without clinical ASCVD and
10-y PREVENT risk ≥10%,
CAC ≥300 AU, or diabetes
Without clinical ASCVD and
10-y PREVENT risk <10%
Figure 18. Adults With Statin-Attributed Muscle Symptoms
