What are the ACC/AHA guidelines to reduce atherosclerotic cardiovascular risk in adults?

Updated: Apr 09, 2021
  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Yasmine S Ali, MD, MSCI, FACC, FACP  more...
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Answer

The ACC/AHA released their recommendations on the treatment of blood cholestrol to reduce atherosclerotic cardiovascular risk in adults in November 2013. [55] See the table below.

Table. Four Statin Benefit Groups and Major Recommendations (Open Table in a new window)

  Group Recommendation
1. Age ≥21 years with clinical ASCVD (including history of or current acute coronary syndrome, myocardial infarction, stable or unstable angina, coronary or other arterial revascularization, stroke, TIA, PAD presurmed to be of atherosclerotic origin)

1.For patients age >75 years, high-intenstiy statin(or moderate-intensity statinif not candidate for high-intensity due to safety concerns)

2. For patients age >75 years, moderate-intensity statin

2.  Adults aged ≥21 years with LDL-C ≥190 mg/dl (not due to modifiable

1. High-intensity statin therapy to achieve ≥50% reduction in LDL-C statin (or moderate-intenstiy if not a candidate for high-intensity statin due to safety concerns)

2. May consider combining statin and non-statin therapy to further reduce LDL-C

3. Cascade screeing of close biologic relatives should be performed to identify others with the disease who would benefit from treatment.

3. Adults aged 40-75 years without ASCVD but with diabetes and with LDL-C 70-189 mg/dL

1. Moderate-intensity statin

2. If 10-year ASCVD risk ≥7.5%, consider high-intensity statin.

4. Adults aged 40-75 years without ASCVD or diabetes, and with LDL-C 70-189 mg/dL and an estimated 10 year risk for ASCVD of ≥7.5%

1. Estimate 10-year ASCVD risk using Pooled Cohort Equations

a. if ≥7.5%, moderate- or high-intensity statin;

b. If ≥to < 7.5%, consider moderate-intensity statin.

2. If selected individuals with 10-year ASCVD risk < 5%, or age < 40 or > 75 years, individualize decisions based on presence of other high-risk features.

3. Before initiation of statin therapy for primary prevention, it is reasonable for clinicians and patients to engage in a discussion that considers the potential for ASCVD risk-reduction benefits and for adverse effects and drug-drug interactions, as well as patient preferences for treatment.

ASCVD = atherosclerotic cardiovascular disease; LDL-C = low-density lipoprotein cholesterol; PAD = peripheral artery disease; TIA = transient ischemic attack.


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