11
Figure 3. Initiating Statin Therapy in Individuals
Without Clinical ASCVD
a
No Clinical ASCVD
Not currently on cholesterol-lowering drugs
Initial evaluation prior to statin initiation
• Fasting lipid panel
a
• ALT
• Hemoglobin A1c (if diabetes status unknown)
• 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
Assign to statin benefit group
(Figure 1a)
Counsel on heart-healthy lifestyle
a
Adapted from Stone NJ, Robinson J, Lichtenstein H, et al. 2013 ACC/AHA Guideline on
the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults:
A Report of the American College of Cardiolog y/American Heart Association Task Force on
Practice Guidelines. doi: 10.1016/j.jacc.2013.11.002.
