Guidelines to Reduce Atherosclerotic Cardiovascular Risk

 

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