The goals of management should be:
(1) patient-centered
(2) evidence-based
(3) a balance between risk versus benefit
One decision was to make changes in the therapeutic targets. These include:
(1) NOT treating LDL-C to achieve a specific concentration
(2) NOT attempting to achieve an absolute minimum LDL-C
(3) NOT treating based on life-time risk
(4) NOT using a non-statin agent that has not been proven to be efficacious
4 high risk groups were identified who are most likely to benefit from statin therapy. An adult is high risk if:
(1) the patient has clinical ASCVD
(2) the patient has primary LDL-C >= 190 mg/dL
(3) the patient is 40 to 75 years old AND has diabetes AND has an LDL-C from 70 to 189 mg/dL
(4) the patient is 40 to 75 years old AND has a 10-year risk for ASCVD >= 7.5% AND has an LDL-C from 70 to 189 mg/dL AND without diabetes or ASCVD
where:
• The 10 year risk for ASCVD is based on the Pooled Cohort Equations.
Management of a patient determined to be at risk involves:
(1) a statin regimen (if possible)
(2) treating secondary disorders (lifestyle, diabetes and other comorbid conditions, drugs) that may be contributing to the dyslipidemia.
