5
Table 4. Recommendations for Treatment of Blood
Cholesterol to Reduce Atherosclerotic
Cardiovascular Risk in Adults—Statin Treatment
(High-, moderate-, and low-statin intensities are defined in Table 2)
Recommendations
Treatment Targets
Î 1. The panel makes no recommendations for or against specific
LDL-C or non-HDL-C targets for the primary or secondary prevention
of ASCVD.
Secondary Prevention
Î 1. High-intensity statin therapy should be initiated or continued
as first-line therapy in women and men ≤75 years of age who have
clinical ASCVD
a
, unless contraindicated. (I-A)
Î 2. In individuals with clinical ASCVD
a
in whom high-intensity statin
therapy would otherwise be used, when high-intensity statin therapy
is contraindicated
b
or when characteristics predisposing to statin-
associated adverse effects are present, moderate-intensity statin
should be used as the second option if tolerated (Table 5 for Safety
of Statins, Recommendation 1). (I-A)
Î 3. In individuals with clinical ASCVD >75 years of age, it is
reasonable to evaluate the potential for ASCVD risk-reduction
benefits and for adverse effects, drug–drug interactions and to
consider patient preferences when initiating a moderate- or high-
intensity statin. It is reasonable to continue statin therapy in those
who are tolerating it. (IIa-B)
Primary Prevention in Individuals ≥21 Years of Age With LDL-C ≥190 mg/dL
Î 1. Individuals with LDL-C ≥190 mg/dL or triglycerides ≥500 mg/dL
should be evaluated for secondary causes of hyperlipidemia (Table
1). (I
c
-B)
Î 2. Adults ≥21 years of age with primary LDL-C ≥190 mg/dL should
be treated with statin therapy (10-year ASCVD risk estimation is not
required): (I
d
-B)
• Use high-intensity statin therapy unless contraindicated.
• For individuals unable to tolerate high-intensity statin therapy, use the maximum
tolerated statin intensity
Î 3. For individuals ≥21 years of age with an untreated primary LDL-C
≥190 mg/dL, it is reasonable to intensify statin therapy to achieve at
least a 50% LDL-C reduction. (IIa-B)
