Population to Screen:
All patients over age 20 should receive one baseline screening if no evidence of a prior screening exists Following baseline screening, initiate 3-5 year screening interval for:
- Men ages 35 and older
- Men ages 20 to 35 with increased risk for coronary heart disease (CHD)
- Women ages 45 and older
- Women ages 20 to 45 with increased risk for CHD
Increased risk for CHD is defined as one or more of the following:
- Diabetes Mellitus (DM)
- History of atherosclerosis
- Tobacco use
- Hypertension
- BMI > 31
- Family history of early cardiovascular disease (Men < 50 yo; Women < 60 yo)
Screening tests:
- Non-fasting lipid panel
- Atherosclerotic Cardiovascular Disease (ASCVD) 10-year risk calculation
Population to Treat:
The decision to initiate statin therapy should be based upon the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Patients in the following groups should receive statin therapy:
- Clinical ASCVD and age ≥ 21
- LDL-C ≥ 190 and age ≥ 21
- DM type 1 or 2 and age 40-75 with LDL-C ≥ 70
- ASCVD 10-year risk ≥ 7.5% and age 40-75
- CKD stage 3 or above (refer to KDIGO guidelines for dosing recommendations)
- Additionally, if a patient meets all criteria for statin therapy besides age, you may consider statin therapy based on clinical judgment
Preferred Statins:
- Moderate-intensity statin: Simvastatin 40mg first line
- High-intensity statin: Atorvastatin 80mg first line - May titrate to a lower dose if patient experiences clinically significant side effects
Follow-up of patients on statin therapy:
A follow-up lipid panel is recommended only if needed to determine patient adherence