8
Treatment
Figure 1. Recommendations for Statin Therapy for
ASCVD Prevention
Colors correspond to the Classes of Recommendations in the ACC/AHA Table (Pages 18-19).
Assessment of the potential for benefit and risk from statin therapy for ASCVD prevention provides
the amework for clinical decision making incorporating patient preferences.
a
Percent reduction in LDL-C can be used as an indication of response and adherence to therapy, but
is not in itself a treatment goal.
c
Consider moderate-intensity statin as more appropriate in low-risk individuals.
d
For those in whom a risk assessment is uncertain, consider factors such as 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 may aid in individual risk assessment may
be identified in the future.
Heart-healthy lifestyle habits are the foundation of ASCVD prevention.
Age >21 y and a
candidate for statin
therapy
Age ≤75 y
High-intensity statin
(Moderate-intensity statin
if not candidate for high-
intensity statin)
Age >75 y OR
if not candidate for high-
intensity statin
Moderate-intensity statin
YES
YES
YES
LDL-C
≥190 mg/dL
NO
High-intensity statin
(Moderate-intensity statin
if not candidate for high-
intensity statin)
YES
Definitions of High- and
Moderate-Intensity Statin
erapy
a
(See Table 2)
High
Daily dose
lowers
LDL-C by
~≥50%
Moderate
Daily dose
lowers
LDL-C by
~30%-<50%
Diabetes
LDL-C
70-189 mg/dL
Age 40-75 y
NO
YES
YES
Moderate-intensity statin
Estimated 10-y ASCVD
risk ≥7.5%
a
High-intensity statin
Primary Prevention
(No diabetes, LDL-C 70 to 189 mg/dL,
and not receiving statin therapy)
Estimate 10-y ASCVD risk every 4-6 y
using Pooled Cohort Equations
b
(See Figure 1A)
NO
Clinical
ASCVD
Regularly monitor
adherence to lifestyle and
drug therapy with lipid
and safety assessments
(See Figure 4)
