43
* For primary prevention recommendations for risk assessment and/or management in the
following patient groups, please see the following: Section 4.2.3.7, "Primary Prevention in
Adults 30 to 79 Years of Age With LDL-C Levels 70 to 189 mg/dL (1.8-4.9 mmol/L)," Section
4.2.4, "Severe Hypercholesterolemia (LDL-C ≥190 mg/dL [4.9 mmol/L])," Section 4.2.5,
"Diabetes in Adults Without Established ASCVD," Section 4.2.7, "Management of Adults With
Subclinical Coronary Atherosclerosis (Men >40 or Women >45 Years)", Section 4.2.8.8, "Adults
With Chronic Disease – Stage 3 or Higher"), and Section 4.2.8.9, "Persons Living With Human
Immunodeficiency Virus (HIV)."
NO
CAC >0*?
NO
YES
High 10-y Risk
(≥10%)
1
CAC assessment
1
Monitor
response
to therapy
Decision
to start LLT
uncertain?
2a
Goal: ≥30% to ≥50%
LDL-C reduction;
LDL-C <100 mg/dL
and non–HDL-C
<130 mg/dL
1
Start moderate- to
high-intensity statin
AND
2a
Goal: ≥50%
LDL-C reduction;
LDL-C <70 mg/dL
and non–HDL-C
<100 mg/dL
1
Start high-intensity
statin
AND
2a
If LDL-C and
non–HDL-C goals
still not achieved,
add ezetimibe
2b
If LDL-C and
non–HDL-C goals
still not achieved,
add PCKS9 mAb or
bempedoic acid
Intermediate 10-y Risk
(5%–<10%)
1
Start health behavior
counseling and repeat
CAC in 3–7 y
2a
Repeat CAC in 3–7 y
AND
