Management of Dyslipidemia and Prevention of Cardiovascular Disease Algorithm

R1. Identify risk factors that enable personalized and optimal therapy for dyslipidemia. (IA)

R2. Based on epidemiologic studies, individuals with type 2 diabetes (T2DM) should be considered as high, very high, or extreme risk for ASCVD. (IIIB)

R3. Based on epidemiologic and prospective cohort studies, individuals with type 1 diabetes (T1DM) and duration more than 15 years or with 2 or more major cardiovascular (CV) risk factors (e.g., albu minuria, chronic kidney disease [CKD] stage 3/4, initiation of intensive control >5 years after diagnosis), poorly controlled hemoglobin A1C (A1C) or insulin resistance with metabolic syndrome should be considered to have risk-equivalence to individuals with T2DM. (IIB)

R4. The 10-year risk of a coronary event (high, intermediate, or low) should be determined by detailed assessment using one or more of the following tools. (IVC)

R5. Special attention should be given to assessing women for ASCVD risk by determining the 10-year risk (high, intermediate, or low) of a coronary event using the Reynolds Risk Score (http://www.reynoldsriskscore.org) or the Framingham Risk Assessment Tool (http://www.framinghamheartstudy.org/risk-functions/coronary-heart-disease/hard-10- year-risk.php). (IV, C)

R6. Dyslipidemia in childhood and adolescence should be diagnosed and managed as early as possible to reduce the levels of LDL-C that may eventually increase risk of CV events in adulthood. (IA)

R7. When the HDL-C concentration is >60 mg/dL, 1 risk factor should be subtracted from an individual’s overall risk profile. (IIB)

R8. A classification of elevated TG should be incorporated into risk assessments to aid in treatment decisions. (IIB)

R9. Individuals should be screened for familial hypercholesterolemia (FH) when there is a family history of:

• Premature ASCVD (definite MI or sudden death before age 55 years in father or other male first- degree relative, or before age 65 years mother or other female first-degree relative) or
• Elevated cholesterol levels (total, non-HDL and/ or LDL) consistent with FH.

(IVC)

R10. Annually screen all adult individuals with T1DM or T2DM for dyslipidemia. (IIB)

R11. Evaluate all adults 20 years of age or older for dyslipidemia every 5 years as part of a global risk assessment. (IVC)

R12. In the absence of ASCVD risk factors, screen middle-aged individuals for dyslipidemia at least once every 1 to 2 years. More frequent lipid testing is recommended when multiple global ASCVD risk factors are present. (IA)

R13. The frequency of lipid testing should be based on individual clinical circumstances and the clinician’s best judgment. (IVC)

R14. Annually screen older adults with 0 to 1 ASCVD risk factor for dyslipidemia. (IA)

R15. Older adults should undergo lipid assessment if they have multiple ASCVD global risk factors (i.e., other than age). (IVC)

R16. Screening for this group is based on age and risk, but not sex; therefore, older women should be screened in the same way as older men. (IA)

R17. In children at risk for FH (e.g., family history of premature cardiovascular disease or elevated cholesterol), screening should be at 3 years of age, again between ages 9 and 11, and again at age 18. (IIIB)

R18. Screen adolescents older than 16 years every 5 years or more frequently if they have ASCVD risk factors, have overweight or obesity, have other ele-ments of the insulin resistance syndrome, or have a family history of premature ASCVD. (IIIB)