48
Management
1
Initiate maximally
tolerated statin
2a
Add inclisiran
†
as
alternative to PCSK9 mAb
1
Add ezetimibe,
a PCSK9 mAb, and/or
bempedoic acid
Goal: LDL-C <70 mg/dL
and non–HDL-C <100 mg/dL
AND
2a
Add inclisiran
†
as
alternative to PCSK9 mAb
1
Add ezetimibe,
a PCSK9 mAb, and/or
bempedoic acid
Goal: LDL-C <100 mg/dL
and non–HDL-C <130 mg/dL
AND
Adults with severe
hypercholesterolemia
(LDL-C ≥190 mg/dL)
Without clinical ASCVD and with a
genetic or clinical confirmation of
HeFH, additional ASCVD risk factors,
or subclinical atherosclerosis*
Without clinical ASCVD and
without additional ASCVD risk
factors, HeFH, or subclinical
atherosclerosis*
1
Rule out or address
secondary causes to
reduce LDL-C
Continued observation
Cascade screen
first-degree relatives and
complete genetic testing
1
AND
Figure 7. Evaluation and Management of Severe
Hypercholesterolemia
