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. One high risk group involves patients with clinical arteriosclerotic cardiovascular disease (ASCVD).


Patient selection: clinical ASCVD and not receiving statin therapy


The patient should be started on a high-intensity statin regimen if all of the following are present:

(1) age <= 75 years of age

(2) no history of statin intolerance

(3) no drug-drug interactions that would prevent statin therapy

(4) no conditions interfering with statin safety


If a patient does not meet the criteria for high-intensity therapy then the patient should be started on a moderate-intensity statin regimen.


A patient started on a statin regimen should be monitored for:

(1) evidence of the expected change in total cholesterol concentration

(2) evidence of adverse effects related to the statin therapy (myopathy, etc)


Additional issues to be addressed:

(1) elevated serum triglyceride concentration (>= 500 mg/dL)

(2) identifying causes of an elevated serum LDL cholesterol concentration (>= 190 mg/dL), primary or secondary

(3) unexplained elevation in serum ALT concentration (greater than 3 times the upper limit of normal)

(4) unhealthy lifestyle choices

(5) any evidence of a pre-existing myopathy


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