Initiating Statin Therapy in Individuals with Clinical ASCVD - Flowchart
Initiating Statin Therapy in Individuals with Clinical ASCVD - Flowchart Hypercholesterolemia Hypercholesterolemia
«Flowchart»

Clinical ASCVD

Not currently on statin therapy

Initial evaluation prior to statin initiation


Fasting lipid panel*
ALT
CK (if indicated)
Consider evaluation for other secondary causes or conditions that may influence statin safety

Clinical ASCVD

Not currently on statin therapy

Initial evaluation prior to statin initiation


Fasting lipid panel*
ALT
CK (if indicated)
Consider evaluation for other secondary causes or conditions that may influence statin safety

Clinical ASCVD

Clinical ASCVD Clinical Clinical

Not currently on statin therapy

Not currently on statin therapy Not currently on statin therapy

Initial evaluation prior to statin initiation

Initial evaluation prior to statin initiation


Fasting lipid panel*
ALT
CK (if indicated)
Consider evaluation for other secondary causes or conditions that may influence statin safety


Fasting lipid panel* * *
ALT
CK (if indicated)
Consider evaluation for other secondary causes or conditions that may influence statin safety

Evaluate and treat laboratory abnormalities


    Triglycerides 500 mg/dL
    LDL–C 190 mg/dL


    Secondary causes
    If primary, screen family for FH


    Unexplained ALT >3X ULN

Evaluate and treat laboratory abnormalities

Evaluate and treat laboratory abnormalities

    Triglycerides 500 mg/dL
    LDL–C 190 mg/dL


    Secondary causes
    If primary, screen family for FH


    Unexplained ALT >3X ULN

Triglycerides 500 mg/dL
LDL–C 190 mg/dL


Secondary causes
If primary, screen family for FH


Secondary causes
If primary, screen family for FH
Unexplained ALT >3X ULN Evaluate and treat laboratory abnormalities

Aged 75 yr
without contraindications, conditions or drug-drug interactions influencing statin safety, or a history of statin intolerance

Aged 75 yr
without contraindications, conditions or drug-drug interactions influencing statin safety, or a history of statin intolerance

Aged 75 yr
without without Aged <=75 yr

Aged >75 yr†
OR
with conditions or drug-drug interactions influencing statin safety, or a history of statin intolerance

Aged >75 yr†
OR
with conditions or drug-drug interactions influencing statin safety, or a history of statin intolerance

Aged >75 yr† † †
OR
with with Aged >75 yr

End

End

End

Initiate high-intensity statin therapy
Counsel on healthy lifestyle habits

Initiate high-intensity statin therapy
Counsel on healthy lifestyle habits

Initiate high-intensity statin therapy
Counsel on healthy lifestyle habits

high-intensity high-intensity high-intensity

Initiate moderate-intensity statin therapy
Counsel on healthy lifestyle habits

Initiate moderate-intensity statin therapy
Counsel on healthy lifestyle habits

Initiate moderate-intensity statin therapy
Counsel on healthy lifestyle habits

moderate-intensity moderate-intensity moderate-intensity

Monitor statin therapy

Monitor statin therapy

Monitor statin therapy

Monitor statin therapy

* Fasting lipid panel is preferred. In a nonfasting individual, a nonfasting non-HDL-C >220 mg/dl may indicate genetic hypercholesterolemia that requires further evaluation or a secondary etiology. If nonfasting triglycerides are >500 mg/dl, a fasting lipid panel is required.

* Fasting lipid panel is preferred. In a nonfasting individual, a nonfasting non-HDL-C >220 mg/dl may indicate genetic hypercholesterolemia that requires further evaluation or a secondary etiology. If nonfasting triglycerides are >500 mg/dl, a fasting lipid panel is required.

* Fasting lipid panel is preferred. In a nonfasting individual, a nonfasting non-HDL-C >220 mg/dl may indicate genetic hypercholesterolemia that requires further evaluation or a secondary etiology. If nonfasting triglycerides are >500 mg/dl, a fasting lipid panel is required.

*

† It is reasonable to evaluate the potential for ASCVD benefits and for adverse effects and to consider patient preferences in initiating or continuing a moderate- or high-intensity statin in individuals with ASCVD >75 years of age.

† It is reasonable to evaluate the potential for ASCVD benefits and for adverse effects and to consider patient preferences in initiating or continuing a moderate- or high-intensity statin in individuals with ASCVD >75 years of age.

† It is reasonable to evaluate the potential for ASCVD benefits and for adverse effects and to consider patient preferences in initiating or continuing a moderate- or high-intensity statin in individuals with ASCVD >75 years of age.

†

ACC, American College of Cardiology; AHA, American Heart Association; ALT, Alanine transaminase; ASCVD, atherosclerotic cardiovascular disease; CK, creatine kinase; FH, familial hypercholesterolemia; LDL-C, low-density lipoprotein cholesterol; ULN, upper limit of normal.

ACC, American College of Cardiology; AHA, American Heart Association; ALT, Alanine transaminase; ASCVD, atherosclerotic cardiovascular disease; CK, creatine kinase; FH, familial hypercholesterolemia; LDL-C, low-density lipoprotein cholesterol; ULN, upper limit of normal.

ACC, American College of Cardiology; AHA, American Heart Association; ALT, Alanine transaminase; ASCVD, atherosclerotic cardiovascular disease; CK, creatine kinase; FH, familial hypercholesterolemia; LDL-C, low-density lipoprotein cholesterol; ULN, upper limit of normal.

ACC AHA ALT ASCVD CK FH LDL-C ULN