Table 1. Summary of Major Recommendations for the
Treatment of Blood Cholesterol to Reduce ASCVD
Risk in Adults
Recommendations
ACC/AHA
COR
ACC/AHA
LOE
A. Heart-healthy lifestyle habits should be encouraged for all individuals.
B. e appropriate intensity of statin therapy should be initiated or continued:
1. Clinical ASCVD
a
a. Age ≤75 y and no safety concerns: High-intensity statin I A
b. Age >75 y or safety concerns: Moderate-intensity statin I A
2. Primary prevention – Primary LDL-C ≥190 mg/dL
a. Rule out secondary causes of hyperlipidemia (Table 3) I B
b. Age ≥21y: High-intensity statin I B
c. Achieve at least a 50% reduction in LDL-C IIa B
d. LDL-C lowering nonstatin therapy may be
considered to further reduce LDL-C
IIb C
3. Primary prevention - Diabetes 40-75 years of age and LDL-C 70-189 mg/dL
a. Moderate-intensity statin I A
b. Consider high-intensity statin when ≥7.5% 10-y
ASCVD risk using the Pooled Cohort Equations
b
IIa B
4. Primary prevention – No diabetes 40-75 years of age and LDL-C 70-189 mg/dL
a. Estimate 10-y ASCVD risk using the Risk Calculator
based on the Pooled Cohort Equations
b
in those
NOT receiving a statin. Estimate risk every 4-6 y.
I B
b. To determine whether to initiate a statin, engage in a
clinician-patient discussion of the potential for ASCVD
risk reduction, adverse effects, drug–drug interactions,
and patient preferences. Re-emphasize heart-healthy
lifestyle habits and address other risk factors.
IIa C
i. ≥7.5% 10-y ASCVD risk:
Moderate- or high-intensity statin
I A
ii. 5 to <7.5% 10-y ASCVD risk:
Consider moderate-intensity statin
IIa B
iii. Other factors may be considered
c
:
LDL-C ≥160 mg/dL, family history of premature
ASCVD, hs-CRP ≥2.0 mg/L, CAC score ≥300
Agaston units, ABI <0.9 or lifetime ASCVD risk
IIb C
5. Primary prevention when LDL-C <190 mg/dL and
age <40 or >75 y, or <5% 10-y ASCVD risk
IIb C
a. Statin therapy may be considered in selected
individuals when a risk decision is uncertain.
c
6. e panel makes no recommendation for initiation of statin therapy for
individuals with NYHA class II-IV heart failure or who are receiving
maintenance hemodialysis.
Treatment
2
