2018 ACC AHA Cholesterol Guidelines
[ASCVD Risk Estimator +][1]
- primary prevention of clinical ASCVD in patients at increased risk but who have not had a vascular event
- secondary prevention of clinical ascvd in patients with preexisting occlusive vascular disease
Figure: ![🏞️][2]
Population Recommendation
Very high-risk ASCVD*
High-intensity statin; add EZE then PCSK9i if LDL-C ≥70
Clinical ASCVD
High-intensity statin (? mod if >75 y), add EZE if LDL-C ≥70
LDL-C ≥190 mg/dL
High-intensity statin; add EZE or PCKS9i if LDL-C ≥100
DM, age 40–75 y
High-intensity statin (? moderate if no CV RFs)
Age 40–75 y (and none of above); calc 10-y risk
≥20%: High-intensity statin 7.5%–<20%: Moderate-intensity statin; if uncertain consider CAC 5–<7.5%: Moderate-intensity statin reasonable <5%: Emphasize lifestyle
ASCVD incl h/o ACS, stable angina, art. revasc, stroke, TIA, PAD. *Multiple major ASCVD events (MI, stroke, sx PAD) or 1 major event + multiple high-risk conditions (age ≥65, DM, HTN, CKD, smoking, FH, prior PCI/CABG). 10-y CV Risk Score: http://my.americanheart.org/cvriskcalculator. Additional risk factors to consider: LDL-C ≥160 mg/dL, met. synd.,CKD, FHx premature ASCVD, hsCRP ≥2 mg/l, Lp(a) ≥50 mg/dL, ABI <0.9, high-risk ethnic groups. top 10 take-home messages for the primary prevention of cardiovascular disease [1]: https://tools.acc.org/ASCVD-Risk-Estimator-Plus/?_ga=2.80208339.558454161.1675265571-1654958744.1672759266#!/calculate/estimate/ [2]: https://i.imgur.com/VBNNACD.png
