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Metabolic Risk

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15 3.4.4: In individuals aged >75 years without diabetes and a 10- year risk ≥7.5%, ES recommends discussing the benefits of statin therapy with the patient based on expected benefits versus possible risks/side effects. (1|⊕⊕⊕ ) Technical Remarks: ▶ Decisions should be made on a case-by-case basis depending on estimates of likely benefits vs. risks in individual patients. ▶ Statin therapy should be calibrated to reach the recommended LDL targets. ➤ 3.5: In individuals at metabolic risk who are taking statins with adequate LDL-C reduction, elevated triglyceride levels [≥200 mg/dL (2.3 mmol/L)], and reduced HDL levels [≤50 mg/dL (1.3 mmol/L) in females, or ≤40 mg/dL (1.0 mmol/L) in males], ES suggests considering fenofibrate adjunct therapy. (2|⊕⊕⊕ ) Technical Remarks: ▶ Avoid gemfibrozil in this situation. ➤ 3.6: In individuals aged 40 years and older at metabolic risk with LDL-C at target, an estimated 10-year ASCVD risk of >7.5% and without clinical ASCVD or other ASCVD risk factors, ES suggests treatment with a moderate-intensity statin. (2|⊕⊕⊕ )

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