Treatment Goals
Achieving LDL-C of this level or lower is recommended for patients with a history of ASCVD at very high risk
what is <55 md/dL?
This highly atherogenic LDL-like particle should now be tested once in every adult
what is lipoprotein(a)?
This risk calculator has replaced the pooled cohort equations and can estimate ASCVD risk starting at age 30
what is PREVENT?
When >50% LDL-C lowering is needed to achieve your target, start with atorvastatin 40-80 mg, or rosuvastatin at one of these two doses.
What is 20 or 40 mg?
Triglyceride levels >500 should in nearly all cases warrant a referral to what resource?
What is a nutritionist?
This biomarker can be used to target residual risk once LDL-C goals are met, especially in patients with diabetes and high triglycerides
what is Apolipoprotein B?
The interval for lipid re-testing recommended for patients already on LDL lowering therapy
What is 6-12 months?
This level of 10-year risk is now considered high risk in primary prevention patients, warranting an LDL-C goal of <70 mg/dL
what is >10%?
This oral LDL lowering medication is still considered second line after statins, but is now recommended in primary prevention populations
What is ezetimibe?
The new approach to risk estimation is known as "C-P-R", which stands for "Calculate-this-Reclassify"
What is Personalize?
General LDL-C treatment goal for patients on statins for primary prevention, if no additional high risk conditions are present
What is <100 mg/dL? (AND 30-49% reduction)
These two comorbidities have been added to diabetes as an automatic indication for statin therapy in adults >40
What are CKD (stage 3+) and HIV?
PCOS has been added to early menopause, defined as occurring prior to this age, as an important risk enhancing factor to consider in determining ASCVD risk
What is <45 years old?
Other reproductive risk markers for women:
- Pre-eclampsia
- Preterm birth (<37 weeks)
- Early menarche (<10 years)
- Recurrent pregnancy loss
- Gestational diabetes
- Gestational hypertension
This siRNA-based PCSK9 inhibitor is recommended by the guidelines as an option that may improve medication adherence
what is inclisiran?
This syndrome which was defined by the AHA in 2023 and emphasizes the linkage between CVD, CKD, DM2 and obesity, is listed as a major risk factor for LDL-C/ApoB discordance
What is CKM syndrome? (Cardiovascular-Kidney-Metabolic syndrome)
Non-HDL-C goal for anyone with an LDL-C goal of <70 mg/dL
what is <100 mg/dL?
The Martin/Hopkins equation or Sampson (NIH) equation should replace the old Friedwald equation, which was previously used to estimate this metric on a lipid panel
What is LDL-C?
What is smoking?
Other, non-modifiable RFs:
Familial hypercholesterolemia
LDL ≥190
Diabetes
Strong family history of premature ASCVD
This inhibitor of cholesterol synthesis which works upstream of statins is now recommended for statin intolerant patients after considering ezetimibe and PSCK9 inhibitors
what is bempedoic acid?
In patients with elevations in both LDL-C and Lp(a), if LDL-C goals are not met on max-dose statin therapy, this class of medications should be used as second line
what are PSCK9 inhibitors?
LDL-C treatment goal for all patients with FH but without clinical ASCVD
what is <70 mg/dL? (previously <100 mg /dL)
Even in patients without a history of clinical ASCVD, a CAC score exceeding this number should warrant an LDL-C goal of <55 mg/dL
what is 1000 Agaston units?
CAC score >100, or over what percentile, is cited as a threshold warranting an LDL-C goal of under 70 mg/dL
what is >75th %ile?
Rosuvastatin, pravastatin, or this other muscle-friendly statin studied in the REPRIEVE trial, are preferred in people living with HIV due to fewer drug interactions.
What is pitavastatin?
Optimal early control of modifiable cardiovascular risk factors is recommended to reduce ASCVD risk in patients with Lp(a) levels above what threshold?
what is >125 nmol/L (or >50 mg/dL)?