Cholesterol Guidelines (United States)

(Modified May 2023)

Click HERE to access the Canadian version of this resource

The 2018 American Heart Association (AHA)/American College of Cardiology (ACC) lipid guidelines represent another paradigm shift in the treatment of dyslipidemia. Specific LDL thresholds are recommended for patients with very high-risk ASCVD or very high baseline LDL. To meet these LDL thresholds, certain non-statin lipid-lowering agents can be used as statin add-ons. Compared to the 2013 guidelines, cardiovascular risk calculators have a more limited role, and more guidance is given regarding use of risk-enhancing factors in making statin therapy decisions for primary prevention. This FAQ below provides a summary of these guidelines and other pertinent information, with an emphasis on pharmacotherapy. For all patients, emphasize a heart-healthy lifestyle to reduce cardiovascular disease risk and as the foundation for treatment of metabolic syndrome.

--Information below is from reference 1 unless otherwise denoted.--

Question

Answer/Pertinent Information

Who should be assessed for cardiovascular risk, and how?

  • A lipid panel is one part of risk screening.
  • In patients <20 years of age, check lipids to rule out familial hypercholesterolemia, if suspected. Some data suggest routine screening of children ≥10 years of age, but this is controversial. Screening is recommended in patients two years of age or older if family history suggests early ASCVD or significant primary hypercholesterolemia. Identification of severe hypercholesterolemia should prompt screening of additional family members.
  • In patients 20 to 39 years of age, assess lipid profile, family history of premature ASCVD, A1c, blood pressure, tobacco use, weight, exercise, and diet. The pooled cohort equations can be used to estimate lifetime ASCVD risk of for patients ≥21 years of age.*
  • In patients 40 to 75 years of age with diabetes and an LDL ≥70 mg/dL a moderate-intensity statin can be started without risk assessment. But it is reasonable to use the pooled cohort equations to estimate 10-year ASCVD risk* for consideration of a high-intensity statin.
  • In patients 20 to 39 years of age with diabetes that is longstanding (≥10 years for type 2 or ≥20 years for type 1) assessment of UACR, kidney function, ABI, retinopathy, or neuropathy may help guide therapy.
  • In patients 40 to 75 years of age, screen for smoking, elevated blood pressure, LDL, and A1c (if indicated). Calculate 10-year ASCVD risk.* Screen for risk-enhancing factors (see footnote c). A lipid panel is used as part of shared decision-making regarding initiation of statin therapy in primary prevention patients.

*The ASCVD Risk Estimator Plus can be used to estimate 10-year ASCVD risk. It uses the pooled cohort equation. It is available at https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/. To calculate lifetime risk (e.g., for patients 21 to 39 years of age), get the spreadsheet at https://tools.acc.org/LDL/ascvd_risk_estimator/index.html#!/calulate/estimator/.

What lifestyle changes are recommended to reduce cardiovascular risk in adults?

  • Adhere to a heart-healthy diet.
    • Eat vegetables, fruits, whole grain, low-fat dairy, poultry, fish, beans, nontropical vegetable oils, and nuts, but avoid red meat (i.e., Mediterranean-style diet, DASH [Dietary Approaches to Stop Hypertension] diet).2
    • Limit sugary drinks and sweets.2
    • Limit saturated and trans-fat to 5% to 6% of calories.2
    • For adults who would benefit from blood pressure reduction, limit sodium intake to 2,400 mg daily (about one teaspoon table salt [kosher/sea salt have less sodium per teaspoon]).2
      • Further reduction to 1,500 mg daily is even more beneficial.2
      • Combine sodium restriction with the DASH diet.2
  • Exercise regularly.
    • Engage in moderate-to-vigorous aerobic activity for at least 40 minutes (on average) three to four times each week.2
  • Avoid tobacco.
  • Maintain a healthy weight.

Who should be treated with a statin?

  • There are four major ACC/AHA statin benefit groups, patients:
    • with clinical ASCVD.
    • with LDL ≥190 mg/dL.
    • 40 to 75 years of age with diabetes (but without clinical ASCVD) and LDL ≥70 mg/dL.
    • 40 to 75 years of age without clinical ASCVD or diabetes, but with LDL 70 to 189 mg/dL and elevated 10-year risk of ASCVD.
      • If estimated risk is 7.5% to <20%, risk enhancers (see footnote c) favor statin therapy and may favor statin therapy even in patients with 5% to 7.5% estimated risk.
      • If the decision regarding statin therapy is unclear in patients with a 7.5% to <20% risk (and select patients with
        5% to <7.5% risk), consider checking a CAC. If CAC is zero, statins can be deferred for five to ten years in patients who do not smoke and who do not have a strong family history of premature ASCVD. Higher scores favor statin therapy, especially in patients ≥55 years of age. Statins are generally indicated for scores ≥100 or ≥75th percentile.
  • The USPSTF recommends a statin for patients 40 to 75 years of age with an estimated 10-year risk of ≥10% plus one or more additional risk factors (e.g., diabetes, dyslipidemia, hypertension, smoking). A statin could also be offered if 10-year risk is 7.5% to <10%, but benefit is likely smaller.8

Are statins appropriate for patients <40 years of age who do not fit into one of the “statin benefit” groups?

  • In patients 20 to 39 years of age with persistent hypercholesterolemia (LDL 160 to 189 mg/dL), a statin would be beneficial, especially if the patient has other risk-enhancing factors (see footnote a).
  • Statins are reasonable in children ≥10 years of age with familial hypercholesterolemia who do not respond to three to six months of lifestyle modification.
  • Starting a statin may be reasonable in patients 20 to 39 years of age with diabetes that is longstanding (≥10 years [type 2] or ≥20 years [type 1]), albuminuria (≥30 mcg/mg creatinine), eGFR <60 mL/min/1.73 m2, ABI <0.9, retinopathy, or neuropathy.

How should patients over
75 years of age be managed?

  • For secondary prevention, use a moderate-intensity statin.
    • If the patient is already taking a high-intensity statin and tolerating it well, it can be continued.
    • It is also reasonable to start a moderate- or high-intensity statin after a risk/benefit discussion.
  • For primary prevention,
    • in patients with diabetes, it is reasonable to continue a statin, or even start a statin after a risk/benefit discussion.
    • in patients with an LDL 70 to 189 mg/dL, starting a moderate-intensity statin may be reasonable after a risk/benefit discussion.
      • In patients 76 to 80 years of age, it may be reasonable to check CAC and forgo statins in patients scoring zero.
    • Keep in mind that results of studies in older patients are conflicting, with few data in patients ≥80 years of age. And statin risks such as myopathy may be higher in older patients.
  • Consider stopping statins in patients with life expectancy <1 year,4,5 dementia, frailty, or multiple comorbidities.

Which patients with diabetes should receive a statin?

  • Statins are indicated for patients 40 to 75 years of age with diabetes and an LDL ≥70 mg/dL for primary prevention.
  • Statins are indicated for patients with diabetes and ASCVD.
  • Starting a statin may be reasonable in patients 20 to 39 years of age with diabetes that is longstanding (≥10 years [type 2] or ≥20 years [type 1]), albuminuria (≥30 mcg/mg creatinine), eGFR <60 mL/min/1.73 m2, ABI <0.9, retinopathy, or neuropathy.

Can statins be used during pregnancy?

  • Statins have long been considered teratogenic; however, this was based on high-dose animal studies.6 Observational data from human pregnancies (mostly first trimester use) suggest that statins don’t increase the risk of major birth defects.6
  • Miscarriage risk is unclear, and because statins inhibit cholesterol production, fetal harm remains a concern.6
  • Although statins are no longer considered contraindicated in pregnancy by the FDA, avoid routine use. Reserve for very high cardiovascular risk patients (e.g., familial hypercholesterolemia, secondary prevention).6 The safest statin alternatives are bile acid sequestrants because they are not systemically absorbed.7
  • Most patients should stop their statin one to two months before planning a pregnancy, or if they become pregnant.1,6
  • Statins may pass into breast milk, posing a theoretical risk to the infant.6

Is it necessary to check a fasting lipid panel?

  • Non-fasting is ok for most patients, but a fasting panel is preferred:
    • when monitoring response to lipid-lowering therapy.
    • in patients ≥20 years of age with initial triglycerides ≥400 mg/dL.
    • when screening for familial lipid disorders.

How are statins used to treat dyslipidemia?

Pharmacotherapy

Use for…

High-intensity statin (average LDL reduction ≥50%):a

  • Atorvastatin 80 mg once daily (40 mg if 80 mg not tolerated).
  • Rosuvastatin 20 mg to 40 mg once daily.b If CrCl <30 mL/min., start with 5 mg (max 10 mg).3 Consider starting with 5 mg in patients of Asian ancestry.3
  • Secondary prevention in adults ≤75 years of age (Level A).
  • Primary prevention in patients 20 to 75 years of age with LDL ≥190 mg/dL (Level B).
  • Primary prevention in patients 40 to 75 years of age with LDL 70 to 189 mg/dL and an estimated 10-year risk of ASCVD of ≥20% or higher, and in select patients with 7.5% to <20% risk (Level A).
  • Primary prevention in patients with diabetes between 40 and 75 years of age with LDL 70 to 189 mg/dL and high risk (e.g., multiple risk factors, age 50 to 75 years) (Level B).

Moderate-intensity statin (average LDL reduction 30% to <50%):a

  • atorvastatin 10 to 20 mg once daily.b
  • fluvastatin 40 mg twice daily or 80 mg (XL) once daily.b In kidney impairment, use 80 mg with caution.3
  • lovastatin 40 to 80 mg once daily. If CrCl<30 mL/min, use caution.3
  • pitavastatin 1 to 4 mg once daily.b If eGFR
    <60 mL/min/1.73m2 or on hemodialysis, start with 1 mg (max 2 mg).3
  • pravastatin 40 to 80 mg once daily.b
    If CrCl <30 mL/min., start with 10 mg (max 40 mg).3
  • rosuvastatin 5 to 10 mg once daily.b
    If CrCl <30 mL/min., start with 5 mg (max 10 mg).3 Consider starting with 5 mg in patients of Asian ancestry.3
  • simvastatin 20 to 40 mg once daily. In severe kidney impairment, start with 5 mg.3
  • Secondary prevention in patients older than 75 years (high-intensity statin is also an option) (Level B).
  • Patients who cannot tolerate a high-intensity statin.
  • Primary prevention in patients 40 to 75 years of age with LDL 70 to 189 mg/dL and an estimated 10-year risk of ASCVD of 7.5% to <20% (high-intensity also an option) (Level A).
  • Primary prevention in diabetes patients 40 to 75 years of age, with LDL 70 to 189 mg/dL (Level A). (Note: high-intensity statin may also be appropriate.)

Pharmacotherapy

Use for…

Low-intensity Statin (average LDL reduction <30%):a

  • fluvastatin 20 to 40 mg once daily.b
  • lovastatin 20 mg once daily.
  • pravastatin 10 to 20 mg once daily. If CrCl <30 mL/min., start with 10 mg (max 40 mg).3
  • simvastatin 10 mg once daily.b In severe kidney impairment, start with 5 mg.3
  • For patients who cannot tolerate a high- or moderate-intensity statin.

How are non-statins used to treat dyslipidemia?

Pharmacotherapy

Use for…

  • Ezetimibe.
  • Bile acid sequestrant.
  • Fibrate. Do not add gemfibrozil to statin therapy.
  • PCSK9 inhibitor: safety past three years is unclear and cost is high. Benefit for event reduction is uncertain in patients without clinical ASCVD.

No proof adding a non-statin to a statin prevents events in patients without clinical ASCVD.

For details about individual agents, see our chart, Non-Statin Lipid-Lowering Agents.

  • Patients with very high-risk ASCVD (e.g., multiple major ASCVD events or one major ASCVD event plus multiple risk factors) who cannot reach an LDL threshold of 70 mg/dL with a statin: ezetimibe add-on is reasonable. Failing that, a PCSK9 inhibitor could be added.
  • Patients 20 to 75 years of age with LDL ≥190 mg/dL who cannot achieve a 50% LDL reduction and/or LDL <100 mg/dL with a statin: ezetimibe add-on is reasonable. If LDL threshold still not met and fasting triglycerides ≤300 mg/dL, add-on bile acid sequestrant can be considered. Failing this, if the patient has multiple risk factors, consider a PCSK9 inhibitor.
  • Patients 30 to 75 years of age with heterozygous familial hypercholesterolemia with an LDL ≥100 mg/dL with a statin and ezetimibe, consider adding a PCSK9 inhibitor.
  • Patients 40 to 75 years of age with LDL ≥220 mg/dL who cannot achieve an LDL <130 mg/dL with a statin and ezetimibe, consider adding a PCSK9 inhibitor.
  • Primary prevention in adults 40 to 75 years of age with LDL 70 to 189 mg/dL and an estimated 10-year risk of ASCVD of 7.5% or higher and CKD, can combine ezetimibe with a moderate-intensity statin.
  • Primary prevention in adults with diabetes and 10-year ASCVD risk ≥20%, it may be reasonable to add ezetimibe to a statin to achieve a ≥50% LDL reduction.
  • Triglycerides ≥500 mg/dL and especially ≥1,000 mg/dL despite lifestyle changes (very low-fat diet with increased omega-3 consumption, cutting refined carbohydrates and alcohol) and ruling out secondary causes: fibrate. Do NOT add gemfibrozil to a statin.
  • For any statin-eligible patient, as a statin substitute in the event of severe or recurrent statin muscle symptoms despite appropriate rechallenge.
What LDL goals can be considered?
  • Most statin clinical trials compared CV outcomes of different statin dose intensities, as opposed to titrating statin doses to achieve a predetermined LDL target.  However, there is evidence that “lower is better” in regard to LDL.
    • In patients achieving LDL <70 mg/dL with standard-dose statin, further LDL reduction is beneficial.9
    • Meta analyses suggest that for every 38.7 mg/dL reduction in LDL, the relative risk of CV events is reduced by 20% to 25%.9,12
    • Adding ezetimibe or a PCSK9 inhibitor to an optimized statin in patients with very high CV risk, while reducing LDL to <55 mg/dL, can further reduce CV risk.10,11
  • There is interindividual variation in LDL response to a given statin dose.  A treat-to-target strategy in a secondary prevention population using an LDL goal of 50 to 70 mg/dL was non-inferior to a high-intensity statin in regard to CV events, suggesting that titrating statins to effect is an approach that can be considered.17
  • The absolute benefit of a given level of LDL reduction depends on baseline CV risk; higher baseline risk means greater absolute benefit.13  Targets can be chosen based on CV risk and patient values and preferences:1,14
    • Very high CV risk (e.g., multiple CV events, or prior CV event plus multiple risks [e.g., diabetes, smoking]: 
      ≥50% LDL reduction and LDL <55 mg/dL.
    • High CV risk (e.g., prior CV event or 10-year CV risk ≥20%, but not very high risk):  ≥50% LDL reduction and
      LDL <70 mg/dL.
    • Intermediate CV risk (e.g.,  10-year CV risk 7.5% to <20%):  ≥30% LDL reduction and LDL <100 mg/dL.

How is statin therapy monitored?

  • Check transaminases at baseline. Unless the patient has chronic stable liver disease, repeat only if signs/symptoms suggesting liver toxicity occur.
  • Check fasting lipid panel four to 12 weeks after statin initiation or dosage change, then every three to 12 months.
    • Check adherence to statin and lifestyle interventions if LDL drop is less than expected.
    • It is not necessary to de-escalate therapy for very low LDL (<40 mg/dL).15  Long-term data with PCSK9 inhibitors show CV benefit without signals for safety concerns.18
  • In patients with chronic inflammatory disease (e.g., rheumatoid arthritis, psoriasis) or HIV, check fasting lipids before and four to 12 weeks after starting a chronic anti-inflammatory drug or antiretroviral. In rheumatoid arthritis patients, reassess lipids and other major risk factors two to four months after disease has been brought under control.
  • Statins seem to cause a small increase in the risk of diabetes (~0.2% absolute risk per year, depending on statin, dose, and underlying diabetes risk factors).  Consider diabetes screening in patients at elevated risk, especially those on a high-intensity statin.16

How are statin side effects managed?

  • Document any pre-existing muscle symptoms before starting a statin to establish a baseline.
  • If severe muscle symptoms or objective weakness occur, hold the statin and check creatine kinase.
  • See our FAQ, Statin Muscle Symptoms: Managing Statin Intolerance, for more information.
  1. Doses listed are for patients with normal kidney function (unless otherwise noted) not taking an interacting medication. High-intensity, moderate-intensity, and low-intensity statin designations are categorical only. Actual statin percent LDL-lowering may vary in practice. Also consider drug interactions and ethnicity (e.g., with rosuvastatin) when choosing a dose.
  2. Atorvastatin 20 mg, fluvastatin extended-release (XL) 80 mg, fluvastatin 20 to 40 mg, pitavastatin, pravastatin 80 mg, rosuvastatin 5 mg and 40 mg, and simvastatin 10 mg are FDA-approved but lack level A-1 evidence for reduction in major cardiovascular events.
  3. Risk-enhancing factors: metabolic syndrome, LDL persistently ≥160 mg/dL, CKD (see below), history of preeclampsia, family history of premature ASCVD, menopause at <40 years of age, chronic inflammatory disease (e.g., rheumatoid arthritis, HIV), ethnicity (e.g., South Asian), triglycerides persistently ≥175 mg/dL.  In some patients (e.g., with estimated 10-year risk ASCVD risk <20%), elevated apolipoprotein B and/or lipoprotein (a), high-sensitivity C-reactive protein ≥2 mg/L, or ABI <0.9, may help inform the risk/benefit discussion regarding statin therapy.    
  • In patients with triglyceride ≥200 mg/dL, apolipoprotein B ≥130 mg/dL corresponds to an LDL ≥160 mg/dL, and thus is a risk-enhancing factor. Persistent apolipoprotein B elevation can also be considered a risk-enhancing factor. Note that measurement may be inaccurate in some labs.
  • Consider checking lipoprotein (a), a particularly atherogenic form of LDL, in patients with a family history of premature ASCVD. Levels ≥50 mg/dL (≥125 nmol/L) may be considered a risk-enhancing factor in men, especially at higher levels. In women, its ability to improve risk prediction is minimal, and only in women with hypercholesterolemia.
  • CKD: use a moderate-intensity statin ± ezetimibe. Do NOT start a statin in dialysis patients, but it is reasonable to continue one if they are already taking it.

Abbreviations: ABI = ankle-brachial index; ASCVD = atherosclerotic cardiovascular disease; CAC = coronary artery calcium; CKD = chronic kidney disease; CrCl = creatinine clearance; CV = cardiovascular; eGFR = estimated glomerular filtration rate; HIV = human immunodeficiency virus; LDL = low-density lipoprotein; USPSTF = United States Preventive Services Task Force.

Levels of Evidence

In accordance with our goal of providing Evidence-Based information, we are citing the LEVEL OF EVIDENCE for the clinical recommendations we publish.

Level

Definition

Study Quality

A

Good-quality patient-oriented evidence.*

  1. High-quality randomized controlled trial (RCT)
  2. Systematic review (SR)/Meta-analysis of RCTs with consistent findings
  3. All-or-none study

B

Inconsistent or limited-quality patient-oriented evidence.*

  1. Lower-quality RCT
  2. SR/Meta-analysis with low-quality clinical trials or of studies with inconsistent findings
  3. Cohort study
  4. Case control study

C

Consensus; usual practice; expert opinion; disease-oriented evidence (e.g., physiologic or surrogate endpoints); case series for studies of diagnosis, treatment, prevention, or screening.

*Outcomes that matter to patients (e.g., morbidity, mortality, symptom improvement, quality of life).

[Adapted from Ebell MH, Siwek J, Weiss BD, et al. Strength of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician 2004;69:548-56. https://www.aafp.org/pubs/afp/issues/2004/0201/p548.html.]

References

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  2. Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014 Jun 24;129(25 Suppl 2):S76-99. Erratum in: Circulation. 2014 Jun 24;129(25 Suppl 2):S100-1. Erratum in: Circulation. 2015 Jan 27;131(4):e326.
  3. Clinical Pharmacology powered by Clinical Key. Tampa, FL: Elsevier; 2022. http://www.clinicalkey.com. (Accessed September 9, 2022).
  4. Tjia J, Briesacher BA, Peterson D, et al. Use of medications of questionable benefit in advanced dementia. JAMA Intern Med. 2014 Nov;174(11):1763-71. Erratum in: JAMA Intern Med. 2014 Dec;174(12):2037.
  5. Kutner JS, Blatchford PJ, Taylor DH Jr, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015 May;175(5):691-700. Erratum in: JAMA Intern Med. 2015 May;175(5):869. Erratum in: JAMA Intern Med. 2019 Jan 1;179(1):126-127.
  6. FDA. FDA Drug Safety Communication. FDA requests removal of strongest warning against using cholesterol-lowering statins during pregnancy; still advises most pregnant patients should stop taking statins. July 20, 2021. https://www.fda.gov/media/150774/download. (Accessed September 10, 2022).
  7. Mehta LS, Warnes CA, Bradley E, et al. Cardiovascular Considerations in Caring for Pregnant Patients: A Scientific Statement From the American Heart Association. Circulation. 2020 Jun 9;141(23):e884-e903. Erratum in: Circulation. 2020 Jun 9;141(23):e904. Erratum in: Circulation. 2021 Mar 23;143(12):e792-e793.
  8. USPSTF. Statin use for the primary prevention of cardiovascular disease in adults: preventive medication. August 23, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/statin-use-in-adults-preventive-medication. (Accessed September 14, 2022).
  9. Cholesterol Treatment Trialists’ (CTT) Collaboration; Baigent C, Blackwell L, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010 Nov 13;376(9753):1670-81.
  10. Cannon CP, Blazing MA, Giugliano RP, et al. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med. 2015 Jun 18;372(25):2387-97.
  11. Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med. 2017 May 4;376(18):1713-1722.
  12. Sabatine MS, Wiviott SD, Im K, et al. Efficacy and Safety of Further Lowering of Low-Density Lipoprotein Cholesterol in Patients Starting With Very Low Levels: A Meta-analysis. JAMA Cardiol. 2018 Sep 1;3(9):823-828.
  13. Cardoso R, Vaishnav J, Martin SS, Blumenthal RS. How low should we decrease LDL-cholesterol in a cost-effective manner? https://www.acc.org/latest-in-cardiology/articles/2018/02/16/09/31/how-low-should-we-decrease-ldl-cholesterol-in-a-cost-effective-manner. (Accessed May 5, 2023).
  14. Writing Committee; Lloyd-Jones DM, Morris PB, et al. 2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2022 Oct 4;80(14):1366-1418. Erratum in: J Am Coll Cardiol. 2023 Jan 3;81(1):104.
  15. Karagiannis AD, Mehta A, Dhindsa DS, et al. How low is safe? The frontier of very low (<30 mg/dL) LDL cholesterol. Eur Heart J. 2021 Jun 7;42(22):2154-2169.
  16. Newman CB, Preiss D, Tobert JA, et al. American Heart Association Clinical Lipidology, Lipoprotein, Metabolism and Thrombosis Committee, a Joint Committee of the Council on Atherosclerosis, Thrombosis and Vascular Biology and Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; and Stroke Council. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. 2019 Feb;39(2):e38-e81.
  17. Hong SJ, Lee YJ, Lee SJ, et al. Treat-to-Target or High-Intensity Statin in Patients With Coronary Artery Disease: A Randomized Clinical Trial. JAMA. 2023 Apr 4;329(13):1078-1087.
  18. Koren MJ, Sabatine MS, Giugliano RP, et al. Long-Term Efficacy and Safety of Evolocumab in Patients With Hypercholesterolemia. J Am Coll Cardiol. 2019 Oct 29;74(17):2132-2146.

Cite this document as follows: Clinical Resource, Cholesterol Guidelines (United States). Pharmacist’s Letter/Prescriber’s Letter. October 2022. [381025]



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