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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.

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