1. The new guidelines recommend initiating moderate or high-intensity statin therapy for patients in four categories based on their cardiovascular risk, rather than targeting a specific LDL-C level. 2. The four categories are: individuals with clinical atherosclerotic cardiovascular disease, LDL-C over 190 mg/dL, diabetes between ages 40-75 with LDL-C 70-189 mg/dL, and 10-year risk over 7.5% for ages 40-75 with LDL-C 70-189 mg/dL. 3. Lipids should be measured during follow-ups to assess adherence, not to achieve a specific target level.

2. I. Introduction to new guidelines on lipid management
II. Comparison with atp III guidelines
III. Current statin treatment recommendations
IV. Current statin safety recommendations

3.  Goal: treatment of blood cholesterol to reduce atherosclerotic
cardiovascular risk in adults, currently the leading cause of
death and disability in America

4.  initiate either moderate-intensity or high-intensity statin therapy for patients who fall into the four
categories
 Unlike atp-iii, Do not titrate to a specific LDL cholesterol target
 Measure lipids during follow-ups to assess adherence to treatment, not to achieve a specific LDL target

5. 1) Individuals with clinical ASCVD
2) Individuals with LDL >190
3) Individuals with dm, 40-75 yo with LDL 70-189 and without
clinical ASCVD
4) Individuals without clinical ASCVD or dm with LDL 70-189 and
estimated 10-year ASCVD risk >7.5%

7. http://clincalc.com/Cardiology/ASCVD/PooledCohort.aspx

8. NO RECOMMENDATIONS ON STATIN THERAPY FOR PTS WITH NYHA CLASS II-
IV OR ESRD ON DIALYSIS (GRADE N RECOOMENDATIONS)

10.  Select the appropriate dose
 Keep potential Side effects and drug-drug interaction In mind
(grade A)
 If high or moderate intensity statin not tolerated, use the
maximum tolerated dose instead

11.  conditions that could predispose pts to statin side effect:
o Impaired renal or hepatic function
o History of previous statin intolerance or muscle disorder
o Age >75
o Unexplained ALT elevation > 3x ULN
o History of hemorrhagic stroke
o Asian ancestry

12.  Check baseline ALT prior initiating the statin (Grade B)
 Check LFTs if patient develops Symptoms of hepatic dysfunction (Grade E)
 If 2 consecutive LDL <40, Consider decreasing the statin dose (Grade C, weak recommendation)
 It may be harmful to initiate simvastatin 80mg, or increase the dose of simvastatin to 80mg (Grade B)

13. 62 year old AA male
Total cholesterol: 140
Low HDL: 35
SBP: 130 mmHg
Not taking anti-hypertensive medications
Non-diabetic
Non-smoker
Calculated 10 yr risk of ASCVD : 9.1%

15.  Moderate to high intensity statin

16. 50 year old white female
Total cholesterol 180
HDL: 50
SBP: 130
taking anti-hTN meds
+diabetic
+smoker
Calculated 10 yr ASCVD: 9.8%

18.  high intensity statin

19. 48 yo white female
Total cholesterol 180
HDL: 55
SBP: 130
Not taking anti-hTN meds
+diabetic
Non-smoker
Calculated 10 yr risk ASCVD : 1.8%

21.  Moderate intensity statin

22. 22 yo white male
LDL: 195
SBP: 120
Not taking anti-hTN meds
Non-diabetic
Non-smoker

24.  High intensity statin

25. 66 yo white female
High Total cholesterol: 230
HDL: 55
SBP: 150
taking anti-hTN meds
Non-diabetic
Non-smoker
Calculated 10 yr risk of ASCVD : 2.0 %

27.  Statin therapy NOT recommended

28. 1. Rather than LDL–C or non-HDL– C targets, new guideline
uses the intensity of statin therapy as the goal of treatment.
2. Know the 4 Statin Benefit Groups:
1. Individuals with clinical ASCVD
2. Individuals with primary elevations of LDL–C ≥190 mg/dL
3. Individuals 40 to 75 years of age with diabetes and LDL–C 70 to189 mg/dL
without clinical ASCVD
4. Individuals without clinical ASCVD or diabetes who are 40 to 75 years of
age with LDL–C 70 to 189 mg/dL and have an estimated 10-year ASCVD
risk of 7.5% or higher. (using the Pooled Cohort Equations for ASCVD
risk prediction)

29. http://clincalc.com/Cardiology/ASCVD/PooledCohort.aspx