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
...gnosis...
...High Blood Cholesterol and ASCVD
2.1. Measurements of LDL-C and Non–H...
...adults who are 20 years of age or...
.... In adults who are 20 years of age or old...
...s with an LDL-C level less than 70 mg/dL (...
4. In adults who are 20 years of age or old...
Treatment
...reatme...
...Therapeutic Modalities...
...ipid-Lowering Drugs Among lipid-lo...
...e 1 High-, Moderate-, and Low-Intens...
...Patient Management...
...1. Secondary ASCVD Preventio...
...In patients who are 75 years of a...
...In patients with clinical ASCVD in...
...ients with clinical ASCVD who are judged to b...
...patients with clinical ASCVD who are...
...ients with clinical ASCVD who are on maximally...
...tement 6. At mid-2018 list prices, PCSK9 i...
...ients older than 75 years of age w...
...n patients older than 75 years of age...
...ents with clinical ASCVD who are receiving m...
...with heart failure (HF) with reduced...
...rosclerotic cardiovascular disease (ASCVD...
...re 1. Secondary Prevention in Patie...
...High-Riska of Future ASCVD EventsHaving tr...
...evere Hypercholesterolemia (LDL-C ≥190 mg...
...n patients 20 to 75 years of age with...
...patients 20 to 75 years of age with an LD...
...s 20 to 75 years of age with a baseline LDL-C...
...30 to 75 years of age with heterozyg...
...40 to 75 years of age with a baseline LDL-C lev...
...t:6. Among patients with FH without evidence...
....3. Diabetes Mellitus in Ad...
...s 40 to 75 years of age with diabetes mellitus, r...
...dults 40 to 75 years of age with diabetes mell...
...s with diabetes mellitus who have multiple ASCVD r...
...der than 75 years of age with diabetes mellit...
.... In adults with diabetes mellitus and...
...In adults older than 75 years with diabe...
...ts 20 to 39 years of age with diabete...
...le 3. Diabetes-Specific Risk Enhancers...
...imary Prevention...
...luation and Risk AssessmentModerate...
...re 2. Primary PreventionFigure 2. Primar...
...-Enhancing Factors for Clinicianâ€...
...revention Adults 40 to 75 Years of...
...intermediate-risk, statin therapy reduces...
...In intermediate-risk patients, LDL-C levels shou...
3. For the primary prevention of clinical ASCVDa...
...and patients should engage in a risk discus...
...In intermediate-risk adults, risk-enhancing...
...te-risk or selected borderline-risk adults, if th...
...mediate-risk adults or selected borderline...
...mediate-risk adults who would benefit from mor...
...In patients at borderline risk, in risk discu...
...of clinical aASCVD includes acute coronary...
...Checklist for Clinician–Patient Shared De...
...cted Examples of Candidates for CAC Measurement Wh...
...g in Response to LDL-C–Lowering Ther...
...ce to changes in lifestyle and effects of...
....4. Primary Prevention in Other Age Groups...
...Adults Additional recommendations for adults...
...lts 75 years of age or older with an LDL-C level...
...adults 75 years of age or older, it may be reaso...
...adults 76 to 80 years of age with an LD...
....4.2. Children and Adolescen...
...dren and adolescents with lipid disorder...
...hildren and adolescents with lipid abnormalities...
.... In children and adolescents 10 years of a...
...and adolescents with a family history of ei...
...children and adolescents found to have moderate...
...dren and adolescents with obesity or o...
...en and adolescents without cardiovascular risk fac...
...history of early aCVD is defined...
.... Normal and Abnormal Lipid Values in Childhooda,b...
....5. Other Populations at Risk
...nicity1. For clinical decision-makin...
.../Ethnic Issues in Evaluation, Risk Decisions,...
...Hypertriglyceridemia...
...20 years of age or older with modera...
...adults 40 to 75 years of age with...
...40 to 75 years of age with severe hypertri...
...s with severe hypertriglyceridemia (fas...
...ues Specific to Women...
...Clinicians should consider conditions sp...
.... Women of childbearing age who are tr...
...en of childbearing age with hypercholest...
...Adults With CK...
...ts 40 to 75 years of age with LDL-C...
...h advanced kidney disease that requires...
.... In adults with advanced kidney disease who re...
...lts With Chronic Inflammatory Disorde...
...ts 40 to 75 years of age with LDL-C 70 to 189 mg/...
...nts with chronic inflammatory disor...
...In adults with RA who undergo ASCVD risk assessm...
...tatin Safety and Statin-Associated Side E...
...n-patient risk discussion is recommended befo...
...s with statin-associated muscle symptoms (SAMS), a...
...tients with indication for statin th...
...n patients with statin-associated sid...
...tients with increased diabetes mellitus risk or...
...treated with statins, it is recommend...
...ts at increased ASCVD risk with chronic, stable l...
...at increased ASCVD risk with severe statin-...
...nzyme Q10 is NOT recommended for routine u...
...nts treated with statins, routine mea...
...tin-Associated Side Effects (SASE)Havin...
...Implementation...
...ns focused on improving adherence to pre...
..., health systems, and health plans should ident...
...fore therapy is prescribed, a patient...
...t-Effectiveness Analysis for PCSK9 Inhibitors...