Key Points
Î Encourage adherence to a heart-healthy lifestyle. A healthy diet,
regular aerobic physical activity, smoking cessation and maintenance
of a healthy weight are critical components of ASCVD risk reduction.
Control hypertension and diabetes, when present.
Î Statin therapy is recommended for adults in groups demonstrated
to benefit. ASCVD risk reduction clearly outweighs the risk of adverse
events based on a strong body of evidence in 4 groups:
• Secondary prevention in individuals with clinical ASCVD
• Primary prevention in individuals age ≥21 years with primary elevations
of LDL-C ≥190 mg/dL
• Primary prevention in individuals with diabetes 40 to 75 years of age
who have LDL-C 70 to 189 mg/dL
• Primary prevention in individual without diabetes and with estimated
10-year ASCVD risk ≥7.5%, 40 to 75 years of age who have LDL-C 70 to
189 mg/dL
Î Statins have an acceptable margin of safety when used in properly
selected individuals and appropriately monitored. If no baseline
abnormality, monitoring of hepatic transaminases is not routinely
needed. CK should not be routinely measured unless there is a personal
or family history of muscle problems. You may need to discontinue and
then restart the statin to determine the cause of muscle symptoms.
Î Engage in a clinician-patient discussion before initiating statin
therapy, especially for primary prevention. Discuss the potential for
ASCVD event reduction, adverse effects, drug–drug interactions, and
patient preferences.
Additional factors may be considered when a risk-based decision is
uncertain.
• These include LDL-C ≥160 mg/dL, family history of premature
ASCVD, hs-CRP ≥2.0 mg/L, CAC ≥300 Agatson units, ABI <0.9;
lifetime risk of ASCVD.
