_______________________________________ Hyperlipidemias and Atherosclerotic Cardiovascular Disease
AHA/ACC RECOMMENDATIONS FOR STATIN THERAPY
Age
Patient Factors
Recommendation
Target % LDL
Patients with ASCVD ≤75 years
Clinical ASCVD
High-intensity statin (initiate or continue) ≥50%
Clinical ASCVD and contraindication to high- intensity statin Clinical ASCVD, at very high risk, being considered for PCKS9 inhibitor therapy Clinical ASCVD, at very high risk, on maximally tolerated LDL-lowering therapy, with LDL ≥70 mg/dL or non-HDL ≥100 mg/dL Clinical ASCVD, on maximally tolerated statin therapy, at very high risk, with LDL ≥70 mg/dL Clinical ASCVD and evaluated for ASCVD risk reduction, statin adverse effects, drug-drug interactions, patient frailty and preferences Currently tolerating high-intensity statin therapy and evaluated for ASCVD risk reduction, statin adverse effects, drug-drug interactions, patient frailty and preferences Clinical ASCVD, currently receiving maximally tolerated statin therapy but LDL level remains ≥70 mg/dL Heart failure and reduced ejection fraction attributable to ischemic heart disease and reasonable life expectancy (3 to 5 years), not on statin therapy due to ASCVD Clinical ASCVD, on maximally tolerated statin therapy, at very high risk, with LDL ≥70 mg/dL LDL ≥190 mg/dL, achieves <50% reduction in LDL while receiving maximally tolerated statin and/or have LDL ≥100 mg/dL Baseline LDL ≥190 mg/dL, achieves <50% reduction in LDL levels and has fasting triglycerides ≤300 mg/dL while taking maximally tolerated statin and ezetimibe therapy Heterozygous FH with LDL ≥100 mg/dL while taking maximally tolerated statin and ezetimibe therapy Baseline LDL ≥220 mg/dL, achieves on-treatment LDL ≥130 mg/dL while receiving maximally tolerated statin and ezetimibe therapy
Moderate-intensity statin (initiate or continue) Maximally-tolerated LDL-lowering therapy (with maximally tolerated statin and ezetimibe) It is reasonable to add PCSKP-I following clinician-patient discussion
30% to 49%
It is reasonable to add ezetimibe
≥75 years
It is reasonable to initiate moderate- or high-intensity statin
30% to 49%
It is reasonable to continue high-intensity statin
It may be reasonable to add ezetimibe
May consider initiation or moderate- intensity statin therapy
It is reasonable to add ezetimibe
Patients with Severe Hypercholesterolemia 20 to 75 years LDL ≥190 mg/dL
Maximally-tolerated statin therapy Ezetimibe therapy is reasonable
≥50%
Consider adding a bile acid sequestrant
30 to 75 years
Consider adding a PCSK9 inhibitor
≥50%
40 to 75 years
Consider adding a PCSK9 inhibitor
≥50%
Table 9 continues on next page.
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MDAK1526
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