41
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
High (≥10%) 10-Year Estimated ASCVD Risk
1 A
7. In adults at high (≥10%) 10-year risk for ASCVD in whom
LLT is initiated for primary prevention, high-intensity statin
therapy is recommended to achieve an LDL-C reduction of
≥50% to reduce the risk of ASCVD.
2a B-R
8. In adults at high (≥10%) 10-year risk for ASCVD in whom
a decision to initiate statin therapy is made, it is reasonable to
treat to a goal of LDL-C <70 mg/dL (1.8 mmol/L) and non–
HDL-C <100 mg/dL (2.6 mmol/L) to reduce ASCVD risk.
2a B-R
9. In adults at high (≥10%) 10-year estimated risk for ASCVD
on maximally tolerated statin, it is reasonable to add
ezetimibe if a goal LDL-C <70 mg/dL (1.8 mmol/L) and
non–HDL-C <100 mg/dL (2.6 mmol/L) is not achieved.
2b B-NR
10. In adults at high (≥10%) 10-year estimated risk for ASCVD
on maximally tolerated statin with or without ezetimibe, it
may be reasonable to add a PCSK9 mAb or bempedoic acid if
a goal LDL-C <70 mg/dL (1.8 mmol/L) and non–HDL-C
<100 mg/dL (2.6 mmol/L) is not achieved to lower LDL-C
and reduce ASCVD risk.
Special Considerations in Primary Prevention
2b B-R
11. In individuals with a life expectancy of <1 year, it may be
reasonable to discontinue LLT that was prescribed for
primary prevention purposes to avoid unnecessary medication
use or adverse medication effects.
3: No
Benefit
B-NR
12. In adults with a baseline untreated LDL-C <70 mg/dL (1.8
mmol/L) and non–HDL-C <100 mg/dL (2.6 mmol/L) and
without additional ASCVD risk factors, initiation of LLT for
primary prevention is unlikely to reduce ASCVD risk.
(cont'd)
