The NEW American Heart Association Guidelines

— Treating to LDL cholesterol targets is no longer recommended; 
rather, clinicians should determine whether a patient falls into one 
of four mutually exclusive high-risk groups and should initiate statin 
therapy as follows:

Patients with clinical atherosclerotic cardiovascular disease (ASCVD) 
should receive high-intensity (age, <75) or moderate-intensity (age, 
≥75) statin therapy.

Patients with LDL cholesterol levels ≥190 mg/dL should receive high-
intensity statin therapy.

Diabetic patients aged 40–75 with LDL cholesterol levels of 70–189 
mg/dL and without clinical ASCVD should receive at least moderate-
intensity statin therapy (and possibly high-intensity statin therapy 
when estimated 10-year ASCVD risk is ≥7.5%).

Patients without clinical ASCVD or diabetes but with LDL cholesterol 
levels of 70–189 mg/dL and estimated 10-year ASCVD risk ≥7.5% 
should receive moderate- or high-intensity statin therapy.

— High-intensity statin therapies are atorvastatin (40–80 mg) or 
rosuvastatin (Crestor; 20–40 mg). Moderate-intensity statin therapies 
include atorvastatin (10–20 mg), rosuvastatin (5–10 mg), 
simvastatin (20–40 mg), pravastatin (40–80 mg), and several others.

— With few exceptions, use of lipid-modifying drugs other than 
statins is discouraged.

— Ten-year ASCVD risk — which includes both coronary events and 
stroke — is determined using an online calculator that can be 
accessed through the AHA and ACC websites. For further discussion of 
the new risk-assessment tool, see NEJM JW Gen Med Nov 12 2013.

— Lifestyle modification is recommended for all patients, regardless 
of cholesterol-lowering drug therapy.

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