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...
...igh Blood Cholesterol and...
...nts of LDL-C and Non–HDL-C...
...ults who are 20 years of age or old...
...who are 20 years of age or older and in whom a...
...ients with an LDL-C level less than 70 mg/d...
...n adults who are 20 years of age or old...
Treatment
...reatment...
...herapeutic Modalities...
...id-Lowering Drugs Among lipid-lowerin...
...le 1 High-, Moderate-, and Low-Intensity Statin...
.... Patient Management Gr...
...condary ASCVD Prevention...
...s who are 75 years of age or younger with clini...
...with clinical ASCVD in whom high-intensity st...
...In patients with clinical ASCVD who ar...
...atients with clinical ASCVD who are judged...
...n patients with clinical ASCVD who are on m...
...lue Statement 6. At mid-2018 list prices, PCSK9...
...lder than 75 years of age with clinic...
...patients older than 75 years of age...
9. In patients with clinical ASCVD who are re...
...In patients with heart failure (HF) with r...
...rosclerotic cardiovascular disease (AS...
...1. Secondary Prevention in Patients With...
...igh-Riska of Future ASCVD EventsHaving...
4.2. Severe Hypercholesterolemia (...
...atients 20 to 75 years of age with an LDL-C...
...patients 20 to 75 years of age with an LDL-...
...n patients 20 to 75 years of age wit...
...ts 30 to 75 years of age with heteroz...
...In patients 40 to 75 years of age with a baseline...
...ent:6. Among patients with FH without evidence...
...Diabetes Mellitus in Adu...
...40 to 75 years of age with diabetes mellitus,...
...to 75 years of age with diabetes mellitus a...
...with diabetes mellitus who have multipl...
...In adults older than 75 years of age with diabetes...
...h diabetes mellitus and 10-year ASCVD risk o...
...adults older than 75 years with diabetes mell...
...20 to 39 years of age with diabetes mellitu...
...3. Diabetes-Specific Risk Enhancers Tha...
...Primary Prevention...
...ion and Risk AssessmentModerate intensity gene...
...ry PreventionFigure 2. Primary Prevention Note...
...e 4. Risk-Enhancing Factors for Clinici...
4.4.2. Primary Prevention Adults 40 to 75 Y...
...s at intermediate-risk, statin thera...
...In intermediate-risk patients, LDL-C le...
...primary prevention of clinical ASCVDa in adult...
4. Clinicians and patients should engage i...
...diate-risk adults, risk-enhancing facto...
...diate-risk or selected borderline-risk...
7. In intermediate-risk adults or selected bo...
...ediate-risk adults who would benefit from more agg...
...at borderline risk, in risk discussion, the pres...
...efinition of clinical aASCVD includes acute co...
...cklist for Clinician–Patient Shar...
...Selected Examples of Candidates f...
.... Monitoring in Response to LDL-C–Low...
...changes in lifestyle and effects of L...
...rimary Prevention in Other Age Groups
...Adults Additional recommendations for adults >7...
...adults 75 years of age or older with an LDL...
...In adults 75 years of age or older, it...
...76 to 80 years of age with an LDL-C le...
...Children and Adolescents...
...n children and adolescents with lipi...
...nd adolescents with lipid abnormaliti...
...n and adolescents 10 years of age or...
...and adolescents with a family history of...
...n children and adolescents found to have...
...hildren and adolescents with obesity or other...
...dren and adolescents without cardiov...
...ory of early aCVD is defined here as...
...e 7. Normal and Abnormal Lipid Values in Chil...
....5. Other Population...
...clinical decision-making in adults of...
...ble 8. Racial/Ethnic Issues in Evaluation, Risk...
...pertriglyceridemia...
...0 years of age or older with moderate hy...
...to 75 years of age with moderate or severe hyp...
...to 75 years of age with severe hypertriglyceridem...
.... In adults with severe hypertriglyceridemi...
...ues Specific to Women...
...should consider conditions specific to women, such...
...childbearing age who are treated with...
...childbearing age with hypercholest...
...Adults With CKD...
.... In adults 40 to 75 years of age...
...dults with advanced kidney disease that...
...ts with advanced kidney disease who require di...
....5. Adults With Chronic Inflammatory...
...In adults 40 to 75 years of age wi...
...with chronic inflammatory disorders or HIV, a fa...
...In adults with RA who undergo ASCVD risk asses...
...tin Safety and Statin-Associated Side Effects...
...A clinician-patient risk discussio...
...atients with statin-associated muscle s...
...In patients with indication for statin therapy,...
...patients with statin-associated side effects that...
...n patients with increased diabetes mellit...
...nts treated with statins, it is recommended...
...In patients at increased ASCVD risk with chronic...
.... In patients at increased ASCVD risk with severe...
...Coenzyme Q10 is NOT recommended for routine u...
...In patients treated with statins,...
...atin-Associated Side Effects (SASE)Having...
...plementation...
...s focused on improving adherence to prescr...
...Clinicians, health systems, and health pl...
...ore therapy is prescribed, a patient-clinician dis...
...3. Cost-Effectiveness Analysis for PCSK9 Inhibi...