Management of Blood Cholesterol
Key Points
Key Points
1. Introduction
- In all individuals, emphasize a heart-healthy lifestyle across the life course.
- In patients with clinical ASCVD, reduce low-density lipoprotein cholesterol (LDL-C) with high-intensity statin therapy or maximally tolerated statin therapy.
- In very high-risk ASCVD, use a LDL-C threshold of 70 mg/dL (1.8 mmol/L) to consider addition of nonstatins to statin therapy. Very high-risk includes a history of multiple major ASCVD events or 1 major ASCVD event and multiple high-risk conditions.
- In patients with severe primary hypercholesterolemia (LDL-C level ≥190 mg/dL [≥4.9 mmol/L]), begin high-intensity statin therapy without calculating 10-year ASCVD risk.
- In patients 40 to 75 years of age with diabetes mellitus and LDL-C ≥70 mg/dL (≥1.8 mmol/L), start moderate-intensity statin therapy without calculating 10-year ASCVD risk.
- In adults 40 to 75 years of age evaluated for primary ASCVD prevention, have a clinician-patient risk discussion before starting statin therapy.
- In adults 40 to 75 years of age without diabetes mellitus and with LDL-C levels ≥70 mg/dL (≥1.8 mmol/L), at a 10-year ASCVD risk of ≥7.5%, start a moderate-intensity statin if a discussion of treatment options favors statin therapy.
- In adults 40 to 75 years of age without diabetes mellitus and 10-year risk of 7.5% to 19.9% (intermediate risk), risk-enhancing factors favor initiation of statin therapy.
- In adults 40 to 75 years of age without diabetes mellitus and with LDL-C levels ≥70 mg/dL to 189 mg/dL (≥1.8–4.9 mmol/L), at a 10-year ASCVD risk of ≥7.5% to 19.9%, if a decision about statin therapy is uncertain, consider measuring coronary artery calcium (CAC).
- Assess adherence and percentage response to LDL-C–lowering medications and lifestyle changes with repeat lipid measurement 4 to 12 weeks after statin initiation or dose adjustment, repeated every 3 to 12 months as needed.
Diagnosis
...2. High Blood Choleste...
...2.1. Measurem...
...In adults who are 20 years of age or older...
...are 20 years of age or older and in w...
...tients with an LDL-C level less than 70 mg/dL (...
...dults who are 20 years of age or older and with...
Treatment
...Treatment...
...3. Therape...
.... Lipid-Lowering Drugs Among lipid-lowering d...
...le 1 High-, Moderate-, and Low-Intensity St...
...4. Patient M...
...4.1. Secondary ASCVD Prev...
...who are 75 years of age or younger wi...
...In patients with clinical ASCVD in whom high...
...with clinical ASCVD who are judged to be very...
...tients with clinical ASCVD who are ju...
...with clinical ASCVD who are on maxim...
...ue Statement 6. At mid-2018 list pric...
...lder than 75 years of age with clinical ASC...
...In patients older than 75 years of age w...
...ith clinical ASCVD who are receiving maximally...
...with heart failure (HF) with reduce...
...inical atherosclerotic cardiovascular...
...igure 1. Secondary Prevention in P...
...Very High-Riska of Future ASCVD EventsHaving t...
4.2. Seve...
...In patients 20 to 75 years of age with an LDL...
...atients 20 to 75 years of age with an LDL...
...patients 20 to 75 years of age with a bas...
...nts 30 to 75 years of age with heterozygous FH an...
...In patients 40 to 75 years of age with a base...
...:6. Among patients with FH without evidence of...
...4.3. Diabete...
...to 75 years of age with diabetes m...
...n adults 40 to 75 years of age with d...
...n adults with diabetes mellitus who...
...der than 75 years of age with diabetes mellitus...
.... In adults with diabetes mellitus and 10-y...
...In adults older than 75 years with diabetes...
...adults 20 to 39 years of age with diabetes mel...
.... Diabetes-Specific Risk Enhancers That Are Ind...
4.4. Primary...
...Evaluation and Risk AssessmentModerate in...
...re 2. Primary PreventionFigure 2. P...
...Risk-Enhancing Factors for Clinician–Pat...
...4.4.2. Primary Prev...
...s at intermediate-risk, statin therapy reduces...
...te-risk patients, LDL-C levels shou...
...he primary prevention of clinical ASCVDa in adult...
...d patients should engage in a risk...
.... In intermediate-risk adults, risk-enhancing...
...iate-risk or selected borderline-risk ad...
7. In intermediate-risk adults or selected bor...
...iate-risk adults who would benefit...
9. In patients at borderline risk, in ris...
...finition of clinical aASCVD includ...
...list for Clinician–Patient Share...
...ted Examples of Candidates for CAC Measurement...
...4.4.3. Monitoring...
...to changes in lifestyle and effects of LDL-...
...4.4.4. Primary Preventio...
...4.4.4.1. Older Adult...
...5 years of age or older with an LDL-C...
...In adults 75 years of age or older, it may...
...adults 76 to 80 years of age with an L...
...4.4.4...
...n and adolescents with lipid disorde...
...children and adolescents with lipid...
...In children and adolescents 10 yea...
...ren and adolescents with a family history of...
...and adolescents found to have moderate or...
...n and adolescents with obesity or othe...
...ren and adolescents without cardiovascular...
...of early aCVD is defined here as MI, documented an...
...mal and Abnormal Lipid Values in Childhoo...
...4.5. Other Popu...
...clinical decision-making in adults of different...
.... Racial/Ethnic Issues in Evaluation, Risk...
...4.5.2. Hyp...
...lts 20 years of age or older with m...
...adults 40 to 75 years of age with moderate o...
...n adults 40 to 75 years of age with s...
...lts with severe hypertriglyceridemia (f...
...4....
...ould consider conditions specific to women, su...
...men of childbearing age who are treat...
...Women of childbearing age with hyperchol...
...4.5.4 Adults Wit...
...n adults 40 to 75 years of age with LDL-C 70...
...ults with advanced kidney disease that requires d...
3. In adults with advanced kidney disease who...
...4.5.5. Ad...
...ts 40 to 75 years of age with LDL-C 70 to 189 mg/d...
...with chronic inflammatory disorders or H...
...with RA who undergo ASCVD risk asse...
...5. Statin Sa...
...A clinician-patient risk discussion is re...
...with statin-associated muscle symptoms (...
...ents with indication for statin therapy, i...
...ients with statin-associated side effects...
...ients with increased diabetes mellitu...
...In patients treated with statins, it is recom...
...In patients at increased ASCVD risk with...
...patients at increased ASCVD risk with...
...Q10 is NOT recommended for routine us...
...ients treated with statins, routine measurem...
...-Associated Side Effects (SASE)Having t...
...6. Implementati...
...tions focused on improving adherence to prescrib...
...ns, health systems, and health plans sho...
...py is prescribed, a patient-clinic...
...t-Effectiveness Analysis for PCSK9...