Hypercholesterolemia Tx algorithm

Question 1

Age 0-19 w/o Hx of FH

Answer 1

lifestyle modifications to prevent/reduce ASCVD risk

Question 2

Age 0-19 w Hx of FH

Answer 2

initiate statin

Question 3

Age 20-39 w/o family Hx of premature ASCVD

Answer 3

estimate lifetime risk to encourage ASCVD lowering lifestyle mods

Question 4

Age 20-39 w family Hx of early ASCVD and LDL >=160mg/dL

Answer 4

consider statin

Question 5

Age 40-75 with LDL 70-189 w/o T2DM and <5% ASCVD risk

Answer 5

lifestyle modifications

<5% = low risk

Question 6

Age 40-75 with LDL 70-189 w/o T2DM and 5-7.5% ASCVD Risk.

Answer 6

If risk enhancers present consider moderate intensity statin

5-7.5% = borderline risk

Question 7

Age 40-75 with LDL 70-189 w/o T2DM and 7.5-<20% ASCVD risk

Answer 7

moderate intensity statin

reduce LDL by 30-40%

7.5 - <20 = intermediate risk

Question 8

Age 40-75 with LDL 70-189 w/o T2DM and >=20 ASCVD risk

Answer 8

statin

reduce LDL by 50% or more

> =20% = high risk

Question 9

LDL >=190 mg/dL

Answer 9

no risk assessment; high intensity statin

Question 10

DM and age 40-75

Answer 10

moderate intensity statin

Question 11

DM and age 40-75

Answer 11

risk assessment to consider high intensity statin

Question 12

ASCVD Risk enhancer lipid/biomarkers?

Answer 12

persistently elevated TG of >= 175mg/dL

Question 13

ASCVD Risk enhancers:

ankle brachial index?

Answer 13

<0.9

Question 14

ASCVD Risk enhancers:

hs-CRP?

Answer 14

> =2.0mg/dL

Question 15

ASCVD Risk enhancers:

Lp(a) levels?

Answer 15

> 50 mg/dL

Question 16

ASCVD Risk enhancers:

apoB?

Answer 16

> =130mg/dL