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Comment
. 2019 Feb 26;321(8):800-801.
doi: 10.1001/jama.2019.0015.

Management of Blood Cholesterol

Francis J Alenghat  1 , Andrew M Davis  1
Affiliations
Comment

Management of Blood Cholesterol

Francis J Alenghat et al. JAMA. .
No abstract available

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure
Figure
Major Recommendations for Management of Blood Cholesterol ASCVD indicates atherosclerotic cardiovascular disease; LDL-C, low-density lipoprotein cholesterol. a Very high-risk ASCVD: multiple major ASCVD events (acute coronary syndrome in past year, prior myocardial infarction or cerebrovascular accident, peripheral artery disease with symptoms or procedure) or 11 major ASCVD event and multiple high-risk conditions (aged ≥65 years, diabetes, hypertension, chronic kidney disease, heart failure, smoking, prior coronary artery bypass graft surgery/percutaneous coronary intervention, persistent LDL-C ≥100 mg/dL). Using 10-year ASCVD risk calculator in primary prevention, high = ≥20%; intermediate = 7.5%−19.9%; borderline = 5%−7.4%; and low = <5%. b High intensity: atorvastatin, 40–80 mg/d; rosuvastatin, 20–40 mg/d. Moderate intensity: atorvastatin, 10–20 mg/d; rosuvastatin, 10 mg/d; simvastatin, 20–40 mg/d; pravastatin or lovastatin, 40 mg/d. Consider high-intensity statin in diabetes for patients aged 50 to 75 years with multiple high-risk conditions. c Reduction of LDL-C level is a secondary goal after reduction of LDL-C percentage is achieved. Consider additional agents (ezetemibe before PCSK9 inhibitors) if LDL-C goals are not met using maximum tolerated statin therapy. d Discuss risk enhancers such as family history of premature ASCVD, chronic inflammatory conditions, metabolic syndrome, South Asian ancestry, elevated lipoprotein(a), etc, as well as coronary artery calcium testing in select intermediate- and borderline-risk patients to potentially reclassify risk.
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