Key points on secondary preventiona

Patient subgroupGuideline recommendation
At very high riskbIf 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 ≤ 75Goal 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 > 75Starting 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.