Major ASCVD events:
(1) acute coronary syndrome within the past 12 months
(2) history of acute myocardial infarction (excluding item 1)
(3) history of ischemic stroke
(4) symptomatic peripheral arterial disease (PAD)
where:
• Symptomatic PAD: one or more of amputation, previous revascularization or (claudication and ABI < 0.85)
High-risk conditions:
(1) age >= 65 years
(2) heterozygous familial hypercholesterolemia
(3) history of prior PCI or CABG outside of events listed above
(4) diabetes mellitus
(5) hypertension
(6) chronic kidney disease with eGFR 15-59 mL per min per 1.73 square meter
(7) current smoking
(8) history of congestive heart failure
(9) persistently elevated LDL-cholesterol (>= 100 mg/dL) despite maximally tolerated statin therapy and ezetimibe
A person is judged to be at very high risk if one of the following:
(1) >= 2 major ASCVD events
(2) 1 major ASCVD event AND "multiple" high risk conditions
A patient judged to be very high risk benefits from aggressive LDL-cholesterol lowering to below 70 mg/dL.
