91
4.2.11. Management of Statin-Attributed Muscle Symptoms
(cont'd)
COR LOE
Recommendations
1 B-R
5. In adults without a history of clinical ASCVD who
experience statin-attributed muscle symptoms on the
recommended intensity of statin therapy (secondary
causes excluded) and are at high ASCVD risk based on
a PREVENT-ASCVD equation of ≥10% or a CAC
score ≥300 AU or diabetes and are unable to achieve
recommended treatment goals, the addition of a PCSK9
mAb is recommended to lower LDL-C.
2a B-NR
6. In adults with clinical ASCVD who experience statin-
attributed muscles symptoms (secondary causes excluded)
and are unable to achieve recommended treatment goals on
bempedoic acid with or without ezetimibe, it is reasonable
to add inclisiran in those unable to tolerate or obtain
evolocumab or alirocumab or who have a strong preference
for less frequent dosing to achieve an LDL-C goal <55 mg/dL
(1.4 mmol/L) and non–HDL-C <85 mg/dL (2.2 mmol/L).
2b B-R
7. In adults without a history of clinical ASCVD who experience
statin-attributed muscle symptoms on the recommended
intensity of statin therapy (secondary causes excluded) and
are at borderline to intermediate ASCVD risk based on a
PREVENT-ASCVD equation of 3% to <10%, and in whom
the decision to treat with ezetimibe and/or bempedoic acid is
uncertain, coronary calcium scoring may be reasonable to aid
in ASCVD risk stratification to inform decision-making about
add-on therapy to reduce ASCVD risk.
2b B-NR
8. In adults without a history of clinical ASCVD who
experience statin-attributed muscle symptoms on the
recommended intensity of statin therapy (secondary causes
excluded) and are at borderline or intermediate ASCVD risk
based on a PREVENT-ASCVD equation of 3% to <10%,
the addition of ezetimibe and/or bempedoic acid may be
reasonable to lower LDL-C to <100 mg/dL (2.6 mmol/L)
and non–HDL-C to <130 mg/dL (3.4 mmol/L) and reduce
ASCVD risk.
