TABLE 7.

Recommended strategies for achieving lipid reduction.

Recommendation	Recommended classification	Evidence level
1. Lifestyle interventions are the foundation of lipid-lowering treatment	I	B
2. Moderate-intensity statins as initiation therapy for achieving lipid-lowering target (Scandinavian Simvastatin Survival Study Group, 1994; Shepherd et al., 1995; Sacks et al., 1996; Downs et al., 1998; Collins et al., 2003; Sever et al., 2003; Colhoun et al., 2004; Nakamura et al., 2006; Zhao et al., 2014; Yusuf et al., 2016a; Diaz et al., 2021)	I	A
3. Combination of cholesterol absorption inhibitors for those who cannot reach LDL-C target with moderate-intensity statin therapy (Cannon et al., 2015; Kim et al., 2022)	I	A
4. Moderate-intensity statins combined with cholesterol absorption inhibitors LDL-C still cannot achieve the target, combined with PCSK9 inhibitors (Sabatine et al., 2017; Schwartz et al., 2018)	I	A
5. Ultra-high-risk patients with high baseline LDL-C levelsa who are expected to have difficulty achieving the target with a statin combined with a cholesterol uptake inhibitor may be initiated directly on statin combined with PCSK9 inhibitor therapy (Sabatine et al., 2017; Schwartz et al., 2018)	IIa	A
6. Patients who cannot tolerate statins should consider cholesterol absorption inhibitors or PCSK9 inhibitors (Moriarty et al., 2015; Nissen et al., 2016; Schreml and Gouni-Berthold, 2018)	IIa	C

LDL-C: low-density lipoprotein cholesterol; PCSK9: proprotein convertase chymotrypsin 9. ^aLDL-C ≥ 2.6 mmol/L in those taking statins and LDL-C ≥ 4.9 mmol/L in those not taking statins.