10
Treatment
Figure 2. Initiating Statin Therapy in Individuals
with Clinical ASCVD
Colors correspond to the class of recommendations in the ACC/AHA Table (Pages 18-19).
a
Fasting lipid panel preferred. In a nonfasting individual, a nonfasting non-HDL-C ≥220 mg/dL
may indicate genetic hypercholesterolemia that requires further evaluation or a secondary etiolog y.
If nonfasting triglycerides are ≥500 mg/dL, a fasting lipid panel is required.
b
It is reasonable to evaluate the potential for ASCVD benefits and for adverse effects, and to consider
patient preferences, in initiating or continuing a moderate- or high-intensity statin, in individuals
with ASCVD >75 years of age.
c
e Pooled Cohort Equations can be used to estimate 10-year ASCVD risk in individuals with and
without diabetes. A downloadable spreadsheet enabling estimation of 10-year and lifetime risk for
ASCVD and a web-based calculator are available at http://www.cardiosource.org/en/Science-And-
Quality/Practice-Guidelines-and-Quality-Standards/2013-Prevention-Guideline-Tools.aspx or
http://my.americanheart.org/cvriskcalculator.
Clinical ASCVD
Not currently on statin therapy
Initial evaluation prior to statin initiation
• Fasting lipid panel
a
• ALT
• CK (if indicated)
• Consider evaluation for other secondary
causes (Table 3) or conditions that may
influence statin safety (Table 5, Rec 1).
Evaluate and Treat Laboratory Abnormalities
1. Triglycerides ≥500 mg/dL
2. LDL-C ≥190 mg/dL
▶ Secondary causes (Table 3)
▶ If primary, screen family for FH
3. Unexplained ALT ≥3 times ULN
Aged ≤75 y without
contraindications, conditions
or drug–drug interactions
influencing statin safety, or a
history of statin intolerance
Aged >75 y
b
OR with
conditions or drug–drug
interactions influencing statin
safety, or a history of statin
intolerance
Initiate high-intensity
statin therapy
Counsel on healthy-
lifestyle habits
Initiate moderate-
intensity statin therapy
Counsel on healthy-
lifestyle habits
Monitor statin therapy (Figure 4)
