primary prevention; LDL more than 190 at any age
start high density statin right away
primary prevention; LDL less than 190, age 40-75 with diabetes
moderate to high-intensity statin depending on ASCVD risk score
primary prevention; LDL less than 190, age 40-75 with no diabetes
calculate the ASCVD risk score
7.5-20% — moderate intensity statin
more than 20 % —- high-intensity statin
for secondary prevention ( patient with known vascular occlusive disease); age less than 75
for secondary prevention, age more than 75
moderate to high intensity statin
per USPSTF – for primary prevention with 1 ASCVD risk factor
threshold for starting statin is 10%
For LIPID screening; AHA /ACC
age 21-75 every 4-6 years. earlier if strong family history
For lipid screening; USPSTF
age 40-75 every 5 years
secondary causes of hyperlipidemia
hypothyroidism, uncontrolled diabetes, excessive alcohol use, smoking, obstructive liver disease, nephrotic syndrome, chronic kidney disease, and certain medications (e.g., thiazides, beta-blockers, glucocorticoids).
what to check if patient develops myalgias on statin
check for hypothyroidism, vitamin-D deficiency. check CK and BMP.
if statins fail?
Consider ezetimibe and/or a PCSK9 inhibitor if strong indication