LDL Goal Based on PREVENT 10-Year ASCVD Risk
| Category | 10-Year ASCVD Risk | Risk Group / LDL Goal |
|---|---|---|
| Low | <3% | No specific LDL goal |
| Borderline | 3-<5% | <100 mg/dL |
| Intermediate | 5-<10% | <100 mg/dL |
| High | ≥10% | <70 mg/dL |
| Extremely High | Secondary prevention | <55 mg/dL |
PREVENT ASCVD Risk Calculator
10-year and 30-year PREVENT ASCVD estimates
Optional
PREVENT Equation
New PREVENT-ASCVD calculator replaces the Pooled Cohort Equation.
- Age 30–79
- LDL 70–189 mg/dL
- No ASCVD or subclinical atherosclerosis
Coronary Artery Calcium
CAC scoring is now recommended for those in whom statin indication is uncertain.
- Men ≥40
- Women ≥45
- Borderline or intermediate risk
- Any scoring on the CAC necessitates an LDL goal < 100
Lipoprotein(a)
- Measure once in adulthood for ALL patients
- Genetically determined, stable overtime
Apolipoprotein B
- Helps assess residual risk when LDL appears controlled
- Reflects number of atherogenic particles
- Most useful in: diabetes, hypertriglyceridemia, CKD, established ASCVD
Medications
- Statins remain first-line therapy
- If additional LDL lowering is needed
- Ezetimibe
- Bempedoic acid
- PCSK9 inhibitors
- Inclisiran in clinical trials
Special Populations
Consider lipid-lowering therapy starting around age 40 in:
- CKD ≥3
- HIV
- T1DM
- T2DM
Other points
- Continue statins in most patients receiving cancer therapy
- Defer most lipid-lowering medications during pregnancy, conception, and lactation
- Universal cholesterol screening between ages 9–11