How Do I Use the New Cholesterol Guidelines?

The AHA/ACC guidelines classify statins as high-, moderate-, or low-intensity.² They also identify four major groups in whom the benefits of statin therapy for reducing ASCVD risk outweigh the risks of therapy. These include patients with

1. Clinical ASCVD (eg, coronary heart disease, stroke, transient ischemic attack, or atherosclerotic peripheral arterial disease)
2. Primary elevated LDL-C ≥ 190 mg/dL
3. Diabetes (specifically, in those ages 40-75 with an LDL-C of 70-189 mg/dL)
4. An estimated 10-year ASCVD risk ≥ 7.5%.^2,3 (A risk calculator can be found at www.cvriskcalculator.com).

Recommended statin regimens for patients meeting these criteria are outlined in the Table.

These new guidelines significantly increase the number of adults who are eligible for statin therapy. The number of adults ages 60 to 75 without cardiovascular disease who now qualify for statin therapy has substantially increased (from 30% to 87% in men and from 21% to 54% among women).⁴ The bulk of this increase is in adults needing primary prevention based on their 10-year cardiovascular risk.⁴ Evidence as to whether expanded use of statins will improve clinical outcomes is still pending. —AF

Ashley Fort
PA Program at Louisiana State University Health Science Center