The ultimate goal of lipid-lowering therapy is to reduce the risk of atherosclerotic cardiovascular disease (ASCVD). Current cholesterol guidelines1 recommend comprehensive assessment of all ASCVD risk factors and a focus on lifestyle counseling. Several patient groups also derive clear benefit from cholesterol-lowering drug therapy to reduce risk. Statins are first-line agents: initiation is recommended for all patients treated for secondary prevention, patients with familial hypercholesterolemia, and essentially all adults aged 40 to 75 years with diabetes. Consideration of statin initiation is recommended in patients treated for primary prevention with estimated 10-year ASCVD risk of 7.5% or more, or certain patients with estimated risk less than 7.5% and risk-enhancing factors (eg, chronic kidney disease, low-density lipoprotein cholesterol [LDL-C] level >160 mg/dL, family history of premature CVD, or a chronic inflammatory condition). In patients with familial hypercholesterolemia who cannot achieve LDL-C lower than 100 mg/dL, or patients treated for secondary prevention who cannot achieve LDL-C lower than 70 mg/dL, drugs like ezetimibe or proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors can be considered to reduce risk further.1
Wilkins JT, Lloyd-Jones DM. Novel Lipid-Lowering Therapies to Reduce Cardiovascular Risk. JAMA. 2021;326(3):266–267. doi:10.1001/jama.2021.2244
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