ACC/AHA guideline on the secondary prevention of hypercholestrolemia
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Template:Hypercholesterolemia Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Individuals with clinical ASCVD are at increased risk for recurrent ASCVD and ASCVD death and a growing body of evidences shows that high-intensity statin therapy reduces ASCVD events more than moderate-intensity statin therapy in individuals with clinical ASCVD.
Secondary Prevention
- High-intensity statin therapy should be initiated for adults ≤75 years of age with clinical ASCVD who are not receiving statin therapy or the intensity should be increased in those receiving a low- or moderate-intensity statin, unless they have a history of intolerance to high-intensity statin therapy or other characteristics that may influence safety.
- In individuals with clinical ASCVD in whom high-intensity statin therapy would otherwise be used, when either high-intensity statin therapy is contraindicated or when characteristics predisposing to statin- associated adverse effects are present, moderate-intensity statin should be used as the second option, if tolerated.
- The use of statin therapy should be individualized in persons >75 years of age with clinical ASCVD, based on the potential for ASCVD risk reduction benefits, the potential for adverse effects and drug-drug interactions, and patient preferences. It is considered reasonable to continue statin therapy in persons >75 years of age who have clinical ASCVD and are tolerating statin therapy. Moderate-intensity statin therapy should be considered for individuals >75 years of age with clinical ASCVD.
Initiating and Management of Statin Therapy in Individuals with Clinical ASCVD
Clinical ASCVD is defined as acute coronary syndromes or history of MI, stable or unstable angina, coronary revascularization, stroke, or TIA presumed to be of atherosclerotic origin, and peripheral arterial disease or revascularization.