Outpatient Cholesterol Screening and Management
Screening: ...

Outpatient Cholesterol Screening and Management

Screening: 2018 ACC/AHA guidelines refine ASCVD risk categories with focus on “risk-enhancing” factors to further adjudicate CV risk

 • Screen adults ≥ 20 years 

 • Fasting not routinely needed unless evaluating for hyperTG; if non-fasting TG >400, then obtain fasting panel

 • AHA criteria for FH: LDL-C >190 and either: 1° relative w/ LDL-C >190 or premature CAD or genetic testing for LDLR, APOB, PCSK9

 • Assess lipids 4-12 wks after initiation of med or dose change, repeat 3-12 mo as needed

Lifestyle modification: weight loss, exercise, smoking cessation, diet low in sat. fat a/w 15-20 mg/dL ↓ in LDL-C, ~50% ↓ risk of CAD

Indications for Lipid-Lowering Therapy

 • Clinical ASCVD - Maximally-tolerated statin to reduce LDL-C by ≥50%

 • LDL-C ≥190 - High-intensity statin; if LDL-C remains ≥100, sequentially consider adding ezetimibe and PCSK9 inhibitor

 • Diabetes (age 40-75) - Moderate-intensity statin; consider high-intensity statin for ASCVD risk >7.5% to reduce LDL-C by ≥50%

 • Age 40-75 w/o above - For low risk <5%, lifestyle changes; borderline risk 5-7.5%, consider mod-intensity statin based on riskenhancers*; intermediate risk 7.5-19.5%, statin to ↓ LDL-C ≥30%; high risk >20%, statin to ↓ LDL-C ≥50%

Statin Potency: High, Medium, Low

Properties of Different Statins

#Lipids #Cholesterol #Screening #Management #diagnosis #pharmacology #primarycare
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