Statin therapy for ASCVD prevention

Template:Hypercholesterolemia Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Major Recommendations for Statin Therapy for ASCVD Prevention

The following is a treatment algorithm proposed by the AHA/ACC guidelines committee:

Initial evaluation prior to statin initiation

Initial evaluation prior to statin initiation include:

• Fasting lipid panel
  • Fasting lipid panel preferred. In a nonfasting individual, a non–HDL-C level !220 mg/dL could indicate genetic hypercholesterolemia that requires further evaluation or a secondary etiology. If nonfasting triglycerides are !500 mg/dL, a fasting lipid panel is required.
• ALT
• CK
• Consider evaluation for other secondary causes

Secondary Cause	Elevated LDL-C	Elevated Triglycerides
Diet	Saturated or trans fats Weight gain Anorexia nervosa	Weight gain, Very-low-fat diets High intake of refined carbohydrates Excessive alcohol intake
Drugs	Diuretics Cyclosporine Glucocorticoids Amiodarone	Oral estrogens Glucocorticoids Bile acid sequestrants Protease inhibitors, Retinoic acid, Anabolic steroids, sirolimus, Raloxifene, Tamoxifen Beta blockers
Diseases	Biliary obstruction Nephrotic syndrome	Nephrotic syndrome Chronic renal failure Lipodystrophies
Disorders and altered states of metabolism	Hypothyroidism Obesity Pregnancy	Diabetes (poorly controlled) Hypothyroidism Obesity Pregnancy

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