Key points on secondary preventiona
| Patient subgroup | Guideline recommendation |
|---|---|
| At very high riskb | If low-density lipoprotein cholesterol (LDL- C) levels are ≥ 70 mg/dL with the maximal tolerated statin therapy, it is reasonable to add ezetimibe If LDL-C level is ≥ 70 mg/dL on maximal tolerated statin and ezetimibe, it is reasonable to add a PCSK9 inhibitor |
| Not at very high risk | |
| Age ≤ 75 | Goal is LDL-C reduction by 50% Use moderate-intensity statins if high- intensity statins are not tolerated If LDL-C ≥ 70 mg/dL on high-intensity statins, it is reasonable to add ezetimibe |
| Age > 75 | Starting or continuing either moderate- or high-intensity statins is reasonable |
↵a Secondary prevention refers to patients with clinical atherosclerotic cardiovascular disease (ASCVD), ie, those with a history of acute coronary syndrome, myocardial infarction, stable or unstable angina, arterial revascularization, stroke, transient ischemic attack, or peripheral artery disease.
↵b Very high risk includes a history of multiple major ASCVD events or 1 major ASCVD event and multiple high-risk conditions (age ≥ 65, heterozygous familial hypercholesterolemia, history of coronary artery bypass surgery or percutaneous coronary intervention, diabetes mellitus, hypertension, chronic kidney disease, current smoking, persistently elevated LDL-C, or history of heart failure).
Based on information in reference 1.