The American College of Cardiology (ACC) and American Heart Association (AHA) released a guideline for the therapy of blood cholesterol intended to reduce the risk of atherosclerotic cardiovascular disease (ASCVD) in an adult.


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



• 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.


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