Hypercholesterolemia Treatment Guidelines

• clinical ASCVD
• diabetes mellitus (type 1 or 2), aged 40 to 75 years and LDL 70 to 189
• LDL >=190
• no diabetes mellitus, no clinical ASCVD, aged 40 to 75 years and LDL 70 to 189, estimated 10 year ASCVD risk >=7.5%

2. Non-treatment group – No need of Statin treatment

• age under 40 or greater than 75 years with no clinical ASCVD
• heart failure – NYHA Class II – IV
• CKD on hemodialysis

3. Patients in Non-treatment group combined with one of the following will need Statin treatment

• family history of premature ASCVD (onset under age 55 years in male relative, or 65 years in a female relative)
• high CRP (over 2 mg/L)
• high coronary calcium score (>=300 Agatston units or >75th percentile)
• ABI under 0.9
• elevated estimated lifetime risk of ASCVD

4. Statin Intensity – recommended based on patient ACVD risk, not on goal LDL targets

• High-intensity statin therapy
  • Daily dose lowers LDL cholesterol by approx. >=50% on average
  • Atorvastatin (40†) – 80 mg
    Rosuvastatin 20 (40) mg
• Moderate-intensity statin therapy
  • Daily dose lowers LDL cholesterol by approx. 30%-50% on average
  • Atorvastatin 10 (20) mg
  • Rosuvastatin (5) 10 mg
  • Simvastatin 20–40 mg‡
  • Pravastatin 40 (80) mg
  • Lovastatin 40 mg
  • Fluvastatin XL 80 mg
  • Fluvastatin 40 mg bid
  • Pitavastatin 2–4 mg
• Low-intensity statin therapy
  • Daily dose lowers LDL cholesterol by approx. <30% on average
  • Simvastatin 10 mg
    Pravastatin 10–20 mg
    Lovastatin 20 mg
    Fluvastatin 20–40 mg
    Pitavastatin 1 mg

5. Statin Safety

• Avoid Statin treatment in women in pregnancy, planning for pregnancy or nursing
• Liver tests – run liver tests before Statin therapy and routine monitoring
• Consider reducing Statin dose only when two consecutive LDL values lower than 40

6. This part is not from the medical treatment guidelines, but as important for everyone who wants to take care of cholesterol issue. Lifestyle changing means a lot in lowering cholesterol for normal people. The change of lifestyle includes eating a heart-healthy diet, becoming more physically active, quitting smoke, losing weight.