28
Management
4.2.3. Primary Prevention in Adults
4.2.3.1. Role of the Individualized Benefit-Risk Discussion
COR LOE
Recommendation
1 B-NR
1. In individuals with dyslipidemia, clinicians and their patients
should engage in a discussion of the patient's ASCVD risk,
healthy lifestyle as the foundation of risk reduction, expected
risk reduction benefits from LLT, possible harms and
DDI, costs, and patient preferences to make individualized
treatment decisions and/or consider additional options for
evaluation to aid in decision-making.
Table 10. Checklist for Individualized Benefit-Risk Discussion
Checklist Item Recommendation
✓
ASCVD risk
assessment
• Perform ASCVD risk assessment (Sections 4.2.3.2 through
4.2.3.7).
• When indicated, use the PREVENT-ASCVD Calculator*.
• Explain risk in absolute and relative terms.
• Use decision tools to explain risk (eg, PREVENT-ASCVD
Calculator*).
• Consider CAC scan or the presence and severity of
atherosclerosis seen on a non-ECG–gated chest CT or a
carotid ultrasound.
• Consider risk enhancers.
• Consider reproductive age risk markers.
✓
Emphasize
healthy lifestyle
habits as the
foundation of
treatment
• Review lifestyle habits (eg, diet, physical activity, weight or
body mass index, and tobacco use).
• Endorse a healthy lifestyle and provide relevant advice,
materials, or referrals (eg, CardioSmart
†
, AHA Life's
Essential 8
‡
, NLA Patient Tear Sheets
§
, PCNA Heart
Healthy Toolbox
||
, cardiac rehabilitation, dietitian, smoking
cessation program).
✓
Potential
net clinical
benefit of
pharmacotherapy
• Recommend a statin as first-line therapy.
• Consider the combination of statin and nonstatin therapy in
selected patients.
• Discuss potential risk reduction from LLT.
• Discuss the potential for adverse effects or drug-drug
interactions.
