The 2013 American College of Cardiology and American Heart Association (ACC/AHA) Guidelines on Treatment to Lower Blood Cholesterol1 recommend high-intensity statin therapy for patients with atherosclerotic cardiovascular disease (ASCVD), with a provision to use nonstatin therapies with proven clinical outcome benefit when the anticipated therapeutic response of at least 50% lowering of low-density lipoprotein cholesterol (LDL-C) level is not seen with high-intensity statin therapy, and further suggest an LDL-C level of at least 100 mg/dL with high-intensity therapy as criteria for adding nonstatin therapy with established clinical benefit. The 2016 ACC Expert Consensus Decision Pathway2 supports this approach.
Smith SC. Defining Potential Use of Nonstatin Therapies to Lower Blood Cholesterol Levels. JAMA Cardiol. 2017;2(9):946–947. doi:10.1001/jamacardio.2017.2290
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