Table 1. Summary of Major Recommendations for the
Treatment of Blood Cholesterol to Reduce ASCVD
Risk in Adults (continued)
Recommendations
ACC/AHA
COR
ACC/AHA
LOE
C. Regularly monitor adherence to lifestyle and drug therapy with lipid and safety
assessments.
1. Assess adherence, response to therapy, and adverse
effects within 4-12 wk following statin initiation or
change in therapy.
I A
a. Measure a fasting lipid panel I A
b. Do not routinely monitor ALT or CK unless symptomatic IIa C
c. Screen and treat type 2 diabetes according to current
practice guidelines. Heart-healthy lifestyle habits should be
encouraged to prevent progression to diabetes
I B
d. Anticipated therapeutic response: approximately ≥50%
reduction in LDL-C from baseline for high-intensity
statin and 30% to <50% for moderate-intensity statin
IIa B
i. Insufficient evidence for LDL-C or non–HDL-C treatment targets from RCTs
ii. For those with unknown baseline LDL-C, an LDL-C <100 mg/dL was
observed in RCTs of high-intensity statin therapy
e. Less than anticipated therapeutic response:
i. Reinforce improved adherence to lifestyle and drug
therapy
I A
ii. Evaluate for secondary causes of hyperlipidemia if
indicated (Table 3)
I A
iii. Increase statin intensity, or if on maximally-tolerated
statin intensity, consider addition of nonstatin therapy
in selected high-risk individuals
d
IIb C
f. Regularly monitor adherence to lifestyle and drug
therapy every 3-12 mo once adherence has been
established. Continued assessment of adherence for
optimal ASCVD risk reduction and safety.
I A
D. In individuals intolerant of the recommended intensity of
statin therapy, use the maximally-tolerated intensity of statin.
I B
1. If there are muscle or other symptoms, establish that
they are related to the statin
IIa B
2. For specific recommendations on managing muscle symptoms (Table 8)
a
Clinical ASCVD includes acute coronary syndromes, history of MI, stable or unstable angina, coronary or other
arterial revascularization, stroke, TIA, or peripheral arterial disease presumed to be of atherosclerotic origin.
b
Estimated 10-year or "hard" ASCVD risk includes first occurrence of nonfatal MI, CHD death, and
nonfatal and fatal stroke as used by the Risk Assessment Work Group in developing the Pooled Cohort
Equations (http://www.cardiosource.org/en/Science-And-Quality/Practice-Guidelines-and-Quality-
Standards/2013-Prevention-Guideline-Tools.aspx or http://my.americanheart.org/cvriskcalculator).
c
ese factors may include primary LDL-C ≥160 mg/dL or other evidence of genetic hyperlipidemias;
family history of premature ASCVD with onset <55 years of age in a first-degree male relative or <65
years of age in a first-degree female relative; hs-CRP ≥2 mg/L; CAC score ≥300 Agatston units or
≥75th percentile for age, sex, and ethnicity (for additional information, see http://www.mesa-nhlbi.
org/CACReference.aspx); ABI <0.9; or lifetime risk of ASCVD. Additional factors that might aid in
individual risk assessment could be identified in the future.
d
High-risk individuals include those with clinical ASCVD, an untreated LDL-C ≥190 mg/dL suggesting
genetic hypercholesterolemia, or diabetes 40-75 years of age and LDL-C 70-189 mg/dL.
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