56
Management
4.2.6. Secondary ASCVD Prevention
COR LOE
Recommendations
Clinical ASCVD Not at Very High Risk*
1 A
1. In adults with clinical ASCVD who are not at very high risk
(Figure 10), high-intensity statin therapy should be initiated
to achieve a ≥50% reduction in LDL-C and a goal of LDL-C
<70 mg/dL (1.8 mmol/L) and non–HDL-C <100 mg/dL to
reduce the risk of recurrent ASCVD events.
2a B-R
2. In adults with clinical ASCVD who are not at very high risk
and on maximally tolerated statin therapy, it is reasonable to
add ezetimibe, a PCSK9 mAb, or bempedoic acid (selection
depending on degree of LDL-C lowering needed and
patient preference) to achieve a goal of LDL-C <70 mg/dL
(1.8 mmol/L) and non–HDL-C <100 mg/dL to reduce the
risk of ASCVD events.
2a B-R
3. In adults with clinical ASCVD who are not at very high risk
and on maximally tolerated statin therapy, it is reasonable to
add ezetimibe, a PCSK9 mAb, or bempedoic acid (selection
based on the degree of LDL-C lowering needed and patient
preference) to achieve a goal LDL-C <55 mg/dL (1.4 mmol/L)
and non–HDL-C <85 mg/dL (2.2 mmol/L) and to reduce the
risk of ASCVD events.
Clinical ASCVD at Very High Risk*
1 A
4. In adults with clinical ASCVD* who are at very high risk
(Figure 10 and Figure 11), high-intensity statin therapy
should be initiated to achieve a ≥50% reduction in LDL-C
and a goal LDL-C <55 mg/dL (1.4 mmol/L) and non–
HDL-C <85 mg/dL (2.2 mmol/L) and to reduce the risk of
ASCVD events.
1 A
5. In adults with clinical ASCVD who are at very high risk
and on maximally tolerated statin therapy, ezetimibe and/
or a PCSK9 mAb should be added (selected based on the
degree of LDL-C lowering needed and patient preference)
to achieve a goal of LDL-C <55 mg/dL (1.4 mmol/L) and
non–HDL-C <85 mg/dL (2.2 mmol/L) to reduce risk of
ASCVD events.
2a B-R
6. In adults with clinical ASCVD who are at very high risk on
maximally tolerated statin therapy, it is reasonable to add
bempedoic acid, with or without ezetimibe and/or PCSK9
mAb, to reach an LDL-C goal <55 mg/dL (1.4 mmol/L) and
non–HDL-C <85 mg/dL (2.2 mmol/L) to reduce the risk of
ASCVD events.
