Summary of key recommendations

Template:Hypercholesterolemia Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Summary of Key Recommendations for the Treatment of Blood Cholesterol to Reduce ASCVD Risk in Adults

B. The appropriate intensity of statin therapy should be initiated or continued

Class I

"1.Clinical ASCVD which includes acute coronary syndromes, history of MI, stable or unstable angina, coronary or other arterial revascularization, stroke, TIA, or peripheral arterial disease presumed to be of atherosclerotic origin (Level of Evidence: A) " Age 75 y and no safety concerns: High-intensity statin. Age >75 y or safety concerns: Moderate-intensity statin.

"2.Primary prevention – Primary LDL-C ‡190 mg/dL (Level of Evidence: B) " Rule out secondary causes of hyperlipidemia Age !21 y: High-intensity statin

"3.Primary preventiondDiabetes 40–75 years of age and LDL-C 70–189 mg/dL (Level of Evidence: A) " Moderate-intensity statin

"4. Primary prevention – No diabetes 40–75 years of age and LDL-C 70–189 mg/dL Estimate 10-y ASCVD risk using the Risk Calculator based on the Pooled Cohort Equationsy in those NOT receiving a statin; estimate risk every 4–6 y (Level of Evidence: B) " Re-emphasize heart-healthy lifestyle habits and address other risk factors ‡7.5% 10-y ASCVD risk: Moderate- or high-intensity statin (Level of Evidence: A) "

Class IIa

"1.Primary prevention – Primary LDL-C ‡190 mg/dL Achieve at least a 50% reduction in LDL-C (Level of Evidence: B) "

"2. Primary preventiondDiabetes 40–75 years of age and LDL-C 70–189 mg/dL Consider high-intensity statin when !7.5% 10-y ASCVD risk using the Pooled Cohort Equations (Level of Evidence: B) "

"3. Primary prevention – No diabetes 40–75 years of age and LDL-C 70–189 mg/dL To determine whether to initiate a statin, engage in a clinician-patient discussion of the potential for ASCVD risk reduction, adverse effects, drug–drug interactions, and patient preferences (Level of Evidence: B) " Re-emphasize heart-healthy lifestyle habits and address other risk factors 5 to <7.5% 10-y ASCVD risk: Consider moderate-intensity statin (Level of Evidence: C) "

Class IIb

"1.Primary prevention – Primary LDL-C ‡190 mg/dL LDL-C lowering nonstatin therapy may be considered to further reduce LDL-C (Level of Evidence: C) "

"2.Primary prevention – No diabetes 40–75 years of age and LDL-C 70–189 mg/dL Re-emphasize heart-healthy lifestyle habits and address other risk factors Other factors may be consideredz: LDL-C !160 mg/dL, family history of premature ASCVD, hs-CRP !2.0 mg/L, CAC score !300 Agaston units, ABI <0.9, or lifetime ASCVD risk (Level of Evidence: C) "

"3.Primary prevention when LDL-C <190 mg/dL and age <40 or >75 y, or <5% 10-y ASCVD risk Statin therapy may be considered in selected individuals (Level of Evidence: C) "

Class III

"1.Statin therapy is not routinely recommended for individuals with NYHA class II-IV heart failure or who are receiving maintenance hemodialysis </ref>(Level of Evidence: A)"

C. Regularly monitor adherence to lifestyle and drug therapy with lipid and safety assessments

Class I

"1.Assess adherence, response to therapy, and adverse effects within 4–12 wk following statin initiation or change in therapy Measure a fasting lipid panel (Level of Evidence: A) " Screen and treat type 2 diabetes according to current practice guidelines. Heart-healthy lifestyle habits should be encouraged to prevent progression to diabetes (Level of Evidence: B) " Less than anticipated therapeutic response: (Level of Evidence: A) " Reinforce improved adherence to lifestyle and drug therapy Evaluate for secondary causes of hyperlipidemia if indicated Regularly monitor adherence to lifestyle and drug therapy every 3–12 mo once adherence has been established. Continue assessment of adherence for optimal ASCVD risk reduction and safety (Level of Evidence: A) "

Class IIa

"1.Assess adherence, response to therapy, and adverse effects within 4–12 wk following statin initiation or change in therapy Do not routinely monitor ALT or CK unless symptomatic (Level of Evidence: C) " Anticipated therapeutic response: approximately !50% reduction in LDL-C from baseline for high-intensity statin and 30% to <50% for moderate-intensity statin(Level of Evidence: B) " Insufficient evidence for LDL-C or non–HDL-C treatment targets from RCTs For those with unknown baseline LDL-C, an LDL-C <100 mg/dL was observed in RCTs of high-intensity statin therapy

Class IIb

"'1.Less than anticipated therapeutic response: (Level of Evidence: C) " Increase statin intensity, or if on maximally-tolerated statin intensity, consider addition of nonstatin therapy in selected high-risk individuals

D. In individuals intolerant of the recommended intensity of statin therapy, use the maximally tolerated intensity of statin

Class I

"1. If there are muscle or other symptoms, establish that they are related to the statin (Level of Evidence: A) "

Class IIa

"1.For specific recommendations on managing muscle symptoms please click here (Level of Evidence: B)"

Class III (Harm)

"1. RECOMMENDATION 1 HERE (Level of Evidence: C)"

"2. RECOMMENDATION 2 HERE (Level of Evidence: C)"

Class III (No Benefit)

"1. RECOMMENDATION 1 HERE (Level of Evidence: C)"

"2. RECOMMENDATION 2 HERE (Level of Evidence: C)"

Class IIa

"1. RECOMMENDATION 1 HERE (Level of Evidence: C)"

"2. RECOMMENDATION 2 HERE (Level of Evidence: C)"

Class IIb

"1. RECOMMENDATION 1 HERE (Level of Evidence: C)"

"2. RECOMMENDATION 2 HERE (Level of Evidence: C)"

References

Template:WikiDoc Sources CME Category::Cardiology