Treatment
14
Medical and Pharmacological Therapy
Risk Assessment and Evaluation
➤ 3.1: In individuals identified as having metabolic risk, ES recommends
global assessment of 10-year risk for either coronary heart disease or
ASCVD to guide the use of medical or pharmacological therapy. (1|⊕⊕⊕
)
Technical Remarks:
▶ Global risk assessment includes the use of one of the established cardiovascular
risk equations.
▶ Elevated low-density lipoprotein (LDL) is indicative of cardiovascular risk.
➤ 3.2: In individuals with low density lipoprotein-cholesterol (LDL-C)
≥190 mg/dL (4.9 mmol/L) or triglycerides ≥500 mg/dL (<5.6 mmol/L),
ES recommends that, before considering the diagnosis of primary
hyperlipidemia, practitioners should rule out secondary causes
of hyperlipidemia. If a secondary cause can be excluded, primary
hyperlipidemia should be suspected. (1|⊕⊕⊕
)
Technical Remark:
▶ Examples of secondary causes of hyperlipidemia include untreated hypothyroidism,
nephrotic syndrome, renal failure, cholestasis, acute pancreatitis, pregnancy,
polycystic ovarian disease, excess alcohol use, treatment with estrogens/oral
contraceptives, antipsychotic agents, glucocorticoids, cyclosporine, protease
inhibitors, retinoids, and beta blockers.
Cholesterol Reduction
➤ 3.3: In individuals 40–75 years of age with LDL-C ≥190 mg/dL (≥5.9
mmol/L), ES recommends high-intensity statin therapy to achieve a LDL-C
reduction of ≥50%. (1|⊕⊕⊕
)
➤ 3.4: In individuals 40–75 years of age with LDL-C 70–189 mg/dL (1.8–4.9
mmol/L) ES recommends a 10-year risk for ASCVD should be calculated.
(1|⊕⊕⊕
)
3.4.1: In individuals 40–75 years of age without diabetes and a
10-year risk ≥7.5%, ES recommends high-intensity statin therapy
either to achieve a LDL-C goal <100 mg/dL (<2.6 mmol/L) or a
LDL-C reduction of ≥50%. (1|⊕⊕⊕
)
3.4.2: In individuals 40–75 years of age without diabetes and a
10-year risk of 5%–7.5%, ES recommends moderate statin therapy
as an option after consideration of risk reduction, adverse events,
drug interactions, and individual preferences to achieve either a
LDL-C goal <130 mg/dL (<3.4 mmol/L) or an LDL-C reduction of
30%–50%. (1|⊕⊕⊕
)
3.4.3: In individuals with metabolic risk, without diabetes, on statin
therapy, ES suggests monitoring glycemia at least annually to
detect new-onset diabetes mellitus. (2|⊕⊕⊕
)
