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Summary of Lipid Guidelines (ACC/AHA)

Patients with ASCVD
< 75 yo should receive high intensity statins [A]
> 75 yo should receive moderate or high intensity statins [E]
Patients with DM
40 - 75 yo, 10 yr risk > 7.5% should receive high intensity statins [E]
40 - 75 yo, 10 yr risk < 7.5% should receive moderate intensity statins [A]
< 40, > 75 yo, 10 yr risk < 7.5% should consider statin therapy (regardless of risk) [E]
Adult Patients with LDL > 190 or TG > 500
Investigate secondary cause
Should receive high intensity statins [E]


The United States Preventive Services Task Force (USPSTF) recommends the threshold of 10% (not 7.5% as recommended by ACC/AHA) to consider initiation of statin therapy (in patients without known heart disease or diabetes).

All patients should undergo lifestyle changes consisting of a diet rich in fruit, vegetables, whole grains, fish, low-fat dairy, lean poultry, nuts, legumes, and non-tropical oils, as well as restricted saturated fats, trans fats, sweets, sugar, sweetened beverages, and sodium. All patients should also engage in regular physical activity and abstain from tobacco use.

High-intensity Statin therapy examples: atorvastatin 40-80mg or rosuvastatin 20-40mg.

Moderate-intensity Statin therapy examples: atorvastatin 10-20mg, rosuvastatin 5-10mg, pravastatin 40-80mg, simvastatin 20-40mg, lovastatin 40mg, fluvastatin 40mg BID, fluvastatin XL 80 mg, or pitavastatin 2-4 mg.

A= Strong evidence to support recommendation, or high certainty based on evidence that net benefit is substantial

B= Moderate certainty based on evidence that net benefit is moderate to substantial, or high certainty that net benefit is moderate

E= Expert opinion, which means "there is insufficient evidence, or evidence is unclear or conflicting, but this is what the Work Group recommends."

Adapted by Wayne Altman, MD with permission from Frank Domino, MD  


Author(s): Wayne Altman, M.D.
Created: Tuesday January 28, 2014
Modified: Wednesday September 25, 2019

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