40
Management
4.2.3.7. Primary Prevention in Adults 30 to 79 Years With
LDL-C Levels 70 to 189 mg/dL (1.8–4.9 mmol/L)
COR LOE
Recommendations
1 A
1. In adults being assessed for primary prevention of ASCVD,
health behavior recommendations should be provided
in addition to a benefit-risk discussion for consideration
of LLT1–4 (Section 4.1.2, "Dietary Approaches in
Dyslipidemia").
Low (<3%) Estimated 10-Year ASCVD Risk
1 A
2. In adults aged 30 to 59 years, at low (<3%) 10-year estimated
risk for ASCVD who have an LDL-C <160 mg/dL (4.1
mmol/L) and a 30-year risk estimate of <10%, counseling on
health behaviors is recommended to reduce LDL-C and risk
for ASCVD.
2a C-LD
3. In adults aged 30 to 59 years, at low (<3%) 10-year estimated
risk for ASCVD but with an LDL-C of 160 to 189 mg/dL
(4.1–4.9 mmol/L) or a 30-year ASCVD risk ≥10% (for those
aged 30-59 years), a moderate-intensity statin is reasonable to
reduce cumulative exposure to atherogenic lipoproteins.
Borderline (3% to <5%) and Intermediate (5% to <10%) 10-Year ASCVD Risk
2a A
4. In adults at borderline (3% to <5%) 10-year estimated risk
for ASCVD in whom a decision is made to initiate statin
therapy for primary prevention, a moderate-intensity statin is
reasonable to achieve ≥30 to 49% LDL-C reduction and to
reduce ASCVD risk.
1 A
5. In adults at intermediate (5% to <10%) 10-year estimated
risk for ASCVD, at least a moderate-intensity statin is
recommended to achieve ≥30 to 49% LDL-C reduction
and to reduce ASCVD risk; for those in the higher end of
this risk range, a high-intensity statin is beneficial to further
reduce LDL-C by ≥50% and reduce ASCVD risk.
2a B-NR
6. In adults at borderline (3% to <5%) or intermediate (5%
to <10%) 10-year estimated risk for ASCVD in whom
statin therapy is initiated, it is reasonable to treat to a goal of
LDL-C <100 mg/dL (2.6 mmol/L) and non–HDL-C <130
mg/dL (3.4 mmol/L) to reduce ASCVD risk.
