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
...iagnosi...
...High Blood Cholesterol an...
...ents of LDL-C and Non–HDL-C...
...dults who are 20 years of age or o...
2. In adults who are 20 years of age o...
...or patients with an LDL-C level less than 70 mg/...
...adults who are 20 years of age or older and withou...
Treatment
...atment
.... Therapeutic Modaliti...
.... Lipid-Lowering Drugs Among lip...
...h-, Moderate-, and Low-Intensity Stati...
...nt Management Groups...
4.1. Secondary ASCVD P...
...who are 75 years of age or younger wi...
...patients with clinical ASCVD in whom...
...ients with clinical ASCVD who are judg...
...tients with clinical ASCVD who are judged to be...
...s with clinical ASCVD who are on maximall...
Value Statement 6. At mid-2018 list prices, PCSK...
7. In patients older than 75 years of age with cli...
...patients older than 75 years of age who are t...
...tients with clinical ASCVD who are receiving maxi...
...ts with heart failure (HF) with reduced eje...
...al atherosclerotic cardiovascular disease (ASCVD)...
...re 1. Secondary Prevention in Patients With Clinic...
...able 2. Very High-Riska of Future A...
...vere Hypercholesterolemia (LDL-C ≥190 mg/dL...
...ts 20 to 75 years of age with an LDL-C level...
...atients 20 to 75 years of age with an LDL-C le...
...In patients 20 to 75 years of age with a...
...ients 30 to 75 years of age with heteroz...
...patients 40 to 75 years of age with a baseline LD...
Value Statement:6. Among patients with FH...
...iabetes Mellitus in Adults...
...In adults 40 to 75 years of age with diabetes mel...
...n adults 40 to 75 years of age with diabetes mell...
...ith diabetes mellitus who have multiple ASCV...
...n adults older than 75 years of age w...
...h diabetes mellitus and 10-year ASCVD...
...lder than 75 years with diabetes mellitus, it...
...to 39 years of age with diabetes mellitus that i...
...e 3. Diabetes-Specific Risk Enhancers That Are...
...Primary Prevention...
...n and Risk AssessmentModerate intensity gene...
.... Primary PreventionFigure 2. Primary Prevent...
...sk-Enhancing Factors for Clinician...
.... Primary Prevention Adults 40 to 75 Years of Ag...
...ults at intermediate-risk, statin ther...
...n intermediate-risk patients, LDL-C levels shou...
.... For the primary prevention of clinical ASCVDa i...
...and patients should engage in a ri...
...In intermediate-risk adults, risk-enh...
...intermediate-risk or selected borderline...
7. In intermediate-risk adults or selecte...
...rmediate-risk adults who would ben...
...s at borderline risk, in risk discussion, t...
...f clinical aASCVD includes acute co...
...5. Checklist for Clinician–Patient Shared...
...elected Examples of Candidates for CA...
...4.3. Monitoring in Response to LDL-C–Lowering...
...Adherence to changes in lifestyle and effects of...
...rimary Prevention in Other Age Groups...
...Older Adults Additional recommendations...
1. In adults 75 years of age or older with an...
2. In adults 75 years of age or older, it...
...In adults 76 to 80 years of age wi...
....2. Children and Adolescents...
...en and adolescents with lipid diso...
...ren and adolescents with lipid abnormalities, li...
...children and adolescents 10 years of age or older...
...nd adolescents with a family history o...
...en and adolescents found to have moderate or se...
.... In children and adolescents with obesity or o...
...hildren and adolescents without cardiovascula...
...f early aCVD is defined here as MI, documented an...
...and Abnormal Lipid Values in Childhooda,bHaving tr...
...her Populations at Risk...
...r clinical decision-making in adults of d...
.../Ethnic Issues in Evaluation, Risk Decisions, and...
...2. Hypertriglycerid...
...In adults 20 years of age or older with modera...
...ults 40 to 75 years of age with modera...
...to 75 years of age with severe hypertriglyceride...
4. In adults with severe hypertriglyceridemia (fa...
...5.3. Issues Specific to Women...
...should consider conditions specific...
...en of childbearing age who are treat...
...Women of childbearing age with hyperch...
....4 Adults With CKD...
...ts 40 to 75 years of age with LDL-C 70 t...
...ults with advanced kidney disease that...
...dults with advanced kidney disease...
...Adults With Chronic Inflammatory...
1. In adults 40 to 75 years of age with LDL...
...with chronic inflammatory disorders or...
...ts with RA who undergo ASCVD risk assessment with...
...tin Safety and Statin-Associated Side...
...an-patient risk discussion is recommended...
...ents with statin-associated muscle sy...
...s with indication for statin therapy, id...
...In patients with statin-associated s...
5. In patients with increased diabetes mellitus...
...patients treated with statins, it is recommend...
...ents at increased ASCVD risk with chro...
...nts at increased ASCVD risk with severe s...
...is NOT recommended for routine use in patients...
...treated with statins, routine measurements...
Table 9. Statin-Associated Side Effe...
...Implementati...
...ntions focused on improving adherence to p...
...linicians, health systems, and health plans sho...
...herapy is prescribed, a patient-clinician discussi...
...gure 3. Cost-Effectiveness Analysis for P...