Mount Carmel Health Partners Clinical Guidelines Hyperlipidemia | Page 3

Four Statin Benefit Groups
1. Individuals 21 years of age or older with a clinical atherosclerotic cardiovascular disease (ASCVD) for secondary prevention -- acute coronary syndromes or a history of myocardial infarction, stable or unstable angina, coronary or other arterial
revascularization, stroke, TIA, or peripheral arterial disease presumed to be of atherosclerotic origin --- without New York
Heart Association (NYHA) class II-IV heart failure or receiving hemodialysis.
• Patients should be treated with a high-intensity statin (may consider moderate-intensity statin if patient is not a
candidate for a high-intensity statin).
2. Individuals 21 years of age or older with primary elevations of low-density lipoprotein cholesterol (LDL-C) greater than 190
mg/dL not ameliorated by diet modification, exercise and weight loss.
• Patients should be treated with a high-intensity statin (may consider moderate-intensity statin if patient is not a
candidate for a high-intensity statin).
3. Individuals 40 - 75 years of age with diabetes and LDL-C 70-189 mg/dL without clinical ASCVD.
• If ASCVD risk is greater than 7.5%, patients should be treated with a high-intensity statin.
• If ASCVD risk is less than 7.5%, patients should be treated with a moderate-intensity statin.
4. Individuals without clinical ASCVD or diabetes who are 40 - 75 years of age with LDL-C 70-189 mg/dL and have an
estimated 10-year ASCVD risk of 7.5% or higher.
• Patients should be treated with a moderate to high-intensity statin.
If a patient does not fit into one of the five statin benefit groups (e.g., LDL 70 to 189 mg/dL [1.8 to 4.9 mmol/L.] with a 10-year
risk 5% to 7.5%), but there is clinical suspicion that the patient may benefit from a statin, additional factors can be taken into
consideration:
• LDL 160 mg/dL or higher or other evidence of genetic hyperlipidemia.
• Cardiovascular disease onset in a first degree male relative before age 55, or in a first-degree female relative before
age 65.
• High-sensitivity C-reactive protein 2 mg/dL or higher.
• Ankle-brachial index less than 0.9.
• Elevated lifetime risk of atherosclerotic cardiovascular disease.
• Coronary artery calcium (CAC) score 300 Agatston units or higher, or 75th percentile or higher for age, gender, and
ethnicity.

Hyperlipidemia - 3